open access

Vol 82, No 4 (2023)
Case report
Submitted: 2022-08-21
Accepted: 2022-10-14
Published online: 2022-11-29
Get Citation

Hypogenetic right lung with partial anomalous pulmonary venous return and accessory diaphragm: a case of “scimitar lung”

C. Melovitz-Vasan1, A. White1, S. Huff2, N. Vasan1
·
Pubmed: 36472398
·
Folia Morphol 2023;82(4):980-987.
Affiliations
  1. Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, New Jersey, United States
  2. Rowan University, Glassboro, New Jersey, United States

open access

Vol 82, No 4 (2023)
CASE REPORTS
Submitted: 2022-08-21
Accepted: 2022-10-14
Published online: 2022-11-29

Abstract

Partial anomalous pulmonary venous return (PAPVR) is a rare congenital cardiovascular
condition in which some of the pulmonary veins drain into the systemic
circulation. We report on the cadaveric dissection of a 71-year-old Caucasian male
donor who died of chronic obstructive pulmonary disease with hypertension. We
noted a faint incisional scar on the thorax extending from the parasternal region
at the 4th intercostal level to the midaxillary line. Since the straight-line incision
followed the ribs and the scar was quite faint, surgery probably occurred when
the donor was young. We also observed numerous surgical interventions of the
heart, lungs, and vasculature to correct various defects.
The morphology of the heart was normal, but was shifted more to the right
side. An atrial septal defect (ASD) was closed with sutures. The right superior
pulmonary vein that drained into the superior vena cava (SVC) was ligated close
to the SVC and the right inferior, left superior, and inferior pulmonary veins all
drained directly into the left atrium. We noticed a dilated coronary sinus entering
the right atrium adjacent to the ASD; the ostium of the coronary sinus noticeably
lacked the normal valve-like structure. We initially thought the right lung was
a “horseshoe” lung, but realised that it was a “hypogenetic” lung with PAPVR and
an accessory diaphragm. Compared to the left, the right secondary bronchi were
much narrower and branched uncharacteristically, as seen in hypogenetic lung
syndrome. The inferior lobe was highly disorganised, severely hypoplastic, and
exhibited uncharacteristic morphology. The superior bronchopulmonary segment
was markedly hypoplastic. The posterior and medial basal segments were not
only hypoplastic and slender, but also extended like a tail to the left pulmonary
cavity behind the heart/pericardium and in front of the oesophagus and aorta.
The right lung, though hypoplastic, demonstrated patent bronchi and the lobes
were inflatable. Based on the hypogenetic lung and PAPVR, we conclude that the
donor exhibited ‘scimitar’ lung.

Abstract

Partial anomalous pulmonary venous return (PAPVR) is a rare congenital cardiovascular
condition in which some of the pulmonary veins drain into the systemic
circulation. We report on the cadaveric dissection of a 71-year-old Caucasian male
donor who died of chronic obstructive pulmonary disease with hypertension. We
noted a faint incisional scar on the thorax extending from the parasternal region
at the 4th intercostal level to the midaxillary line. Since the straight-line incision
followed the ribs and the scar was quite faint, surgery probably occurred when
the donor was young. We also observed numerous surgical interventions of the
heart, lungs, and vasculature to correct various defects.
The morphology of the heart was normal, but was shifted more to the right
side. An atrial septal defect (ASD) was closed with sutures. The right superior
pulmonary vein that drained into the superior vena cava (SVC) was ligated close
to the SVC and the right inferior, left superior, and inferior pulmonary veins all
drained directly into the left atrium. We noticed a dilated coronary sinus entering
the right atrium adjacent to the ASD; the ostium of the coronary sinus noticeably
lacked the normal valve-like structure. We initially thought the right lung was
a “horseshoe” lung, but realised that it was a “hypogenetic” lung with PAPVR and
an accessory diaphragm. Compared to the left, the right secondary bronchi were
much narrower and branched uncharacteristically, as seen in hypogenetic lung
syndrome. The inferior lobe was highly disorganised, severely hypoplastic, and
exhibited uncharacteristic morphology. The superior bronchopulmonary segment
was markedly hypoplastic. The posterior and medial basal segments were not
only hypoplastic and slender, but also extended like a tail to the left pulmonary
cavity behind the heart/pericardium and in front of the oesophagus and aorta.
The right lung, though hypoplastic, demonstrated patent bronchi and the lobes
were inflatable. Based on the hypogenetic lung and PAPVR, we conclude that the
donor exhibited ‘scimitar’ lung.

Get Citation

Keywords

scimitar lung, congenital cardiovascular anomaly, partial anomalous pulmonary venous return (PAPVR), partial anomalous pulmonary venous connection (PAPVC)

About this article
Title

Hypogenetic right lung with partial anomalous pulmonary venous return and accessory diaphragm: a case of “scimitar lung”

Journal

Folia Morphologica

Issue

Vol 82, No 4 (2023)

Article type

Case report

Pages

980-987

Published online

2022-11-29

Page views

922

Article views/downloads

559

DOI

10.5603/FM.a2022.0098

Pubmed

36472398

Bibliographic record

Folia Morphol 2023;82(4):980-987.

Keywords

scimitar lung
congenital cardiovascular anomaly
partial anomalous pulmonary venous return (PAPVR)
partial anomalous pulmonary venous connection (PAPVC)

Authors

C. Melovitz-Vasan
A. White
S. Huff
N. Vasan

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