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Figure 5d. Total anomalous pulmonary venous drainage in a 9-month-old girl. (a) Frontal chest radiograph shows increased pulmonary vasculature in the right lung, a finding that suggests obstruction of the right pulmonary veins. Arrow indicates the dilated superior vena cava. (b, c) Anterior (b) and posterior (c) VR MR angiographic images help confirm the asymmetric caliber of the peripheral pulmonary vessels but help exclude intrinsic obstruction of the pulmonary veins. The individual pulmonary veins (*) join together in a retrocardial venous confluence (**), which drains unobstructed into the dilated superior vena cava (arrows). The azygos vein (az) is located more laterally. (d, e) Short-axis (d) and horizontal long-axis (e) cine images show that the right ventricle (RV) and right atrium (RA) are markedly dilated and that the venous confluence (**) does not communicate with the atria. The ASD is not shown on these images. LA = left atrium, LV = left ventricle. (See also Movies 3 and 4 at radiographics.rsnajnls.org/cgi/content/full/27/1/5/DC1.)
