12 Pulmonary Varix

Clinical Presentation

65-year-old woman with chest pain

Radiologic Findings

PA (Fig. 12.1) and lateral (Fig. 12.2) chest radiographs demonstrate a multi-lobular soft-tissue mass that projects over the right hilum (Fig. 12.1) and focal enlargement of the superior aspect of the left atrium (Fig. 12.2). Nodular upper lobe parenchymal opacities represented remote granulomatous infection. Contrast-enhanced chest CT (Figs. 12.3, 12.4) shows that the lobular opacities seen on radiography correspond to focal dilatation of the pulmonary veins as they enter an enlarged left atrium.

Diagnosis

Pulmonary Varix

Differential Diagnosis

• Indeterminate Pulmonary Nodule/Mass

Fig. 12.1

Fig. 12.2

Fig. 12.3

Fig. 12.4

Discussion

Background

Pulmonary varix is a rare lesion characterized by focal non-obstructive aneurysmal enlargement of one or more pulmonary veins prior to entering the left atrium.

Etiology

Both acquired and congenital etiologies of pulmonary varix have been proposed. Pulmonary varix is typically associated with mitral valve dysfunction, particularly insufficiency. In these cases, the right pulmonary veins are typically affected.