This 19 year old girl was referred with repeated episodes of cough and right basal changes on the plain film. The episodes were occasionally febrile. Our differential was abruptly shortened when the radiographer reported that she had an old median sternotomy. She did not know what the operation was, as it was done in early childhood. We were struck by the mild hypoplasia of the right lung: when there is a question of congenital lung dysplasia it was our habit to include a V/Q scan (below)
So, hardly any flow to the right lung, and the ventilation images supported the impression of a small right lung. Next day we obtained her old films and notes.
She had presented at age five with signs of an ASD, but on angiography there was an associated drainage of the right upper pulmonary vein to the low SVC. Repair was undertaken but post-operative fibrosis had slowly surrounded the right pulmonary veins and occluded them. Her symptoms were due to episodes of right sided pulmonary oedema.
In my opinion, surgical correction of anomalous pulmonary venous drainage, with or without and ASD (which if present is of the sinus venosus type) is quite a surgical challenge. Post-operative stenosis of the pulmonary veins or of (as above) the SVC is well recognised, and may require reoperation or stenting as appropriate.