Vena pulmonalis

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Artificially colored 3D rendering of a high resolution computed tomography of a normal thorax of a 37 year old man who presented with unspecific breathing problems, published with written informed consent. The anterior thoracic wall, the airways and the pulmonary vessels anterior to the root of the lung have been digitally removed in order to visualize the different levels of the pulmonary circulation.
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Artificially
colored high resolution computed tomography of a normal lung, using a 1 cm thick maximum intensity projection in order to visualize the different levels of pulmonary arteries and veins.
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Anomalous
pulmonary venous drainage: a pictorial essay with a CT focus. Embryology of anomalous pulmonary venous drainage. This diagram illustrates right sided pulmonary veins failing to establish a normal connection with the left atrium and instead draining into the inferior vena cava. UV = Umbilicovitelline vein; CCV = Common cardinal vein; LB = Lung buds; LA = Left atrium; RA = Right atrium; LV = Left ventricle; RV = Right ventricle; SVC = Superior vena cava; IVC = Inferior vena cava; ARPV = Anomalous right pulmonary vein
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Anomalous
pulmonary venous drainage: a pictorial essay with a CT focus. Normal pulmonary venous anatomy and normal variants. 3D CT reconstructions of the left atrium and pulmonary veins, posterior views. a Normal pulmonary venous anatomy. (1) Left superior pulmonary vein, (2) Left lower pulmonary vein, (3) Right superior pulmonary vein, (4) Right inferior pulmonary vein. b Normal variant right middle pulmonary vein (arrowhead). c Single conjoined left pulmonary vein (asterisk). d Anatomical variant with conjoined ostium (black arrow) of the left inferior pulmonary vein (2) and right inferior pulmonary vein (4)
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The pulmonary veins drain oxygenated blood from the lungs to the left atrium. A small amount of blood is also drained from the lungs by the bronchial veins

Gross anatomy

There are typically four pulmonary veins, two draining each lung:

The pulmonary veins course in the intersegmental septa and as such do not run with the bronchi like the pulmonary arteries do.

The superior pulmonary veins take an oblique inferomedial course whereas the inferior pulmonary veins run horizontally peripherally before taking a more vertical course. They pass through the lung hilum, antero-inferiorly to the pulmonary arteries, forming a short intrapericardial segment, to drain into the left atrium. The ostia of the inferior pulmonary veins are more posteromedial and the left pulmonary veins being more superior.

There is extensive communication with deep bronchial veins within the lung and with the superficial bronchial veins at the hilum.

The pulmonary veins are covered by a short (~9 mm) myocardial layer, which is often the electrical focus of atrial fibrillation with the left superior pulmonary vein being the foci for almost half of cases. These abnormal foci can be treated with RFA.

Variant anatomy

Typical anatomy described above is found in ~70% of patients . Variant configurations are more common on the right and include:

  • common trunks
    • common draining trunk of left superior and inferior pulmonary veins
  • accessory (additional pulmonary veins)
    • single accessory right middle pulmonary vein (~10%)
    • two accessory right middle pulmonary veins
    • one accessory right middle pulmonary vein and one accessory right upper pulmonary vein 
    • superior segment right lower lobe vein 
    • basilar segment right lower lobe vein
    • right top pulmonary vein (drains mostly posterior segment of right upper lobe and subsegmental areas of the superior segment of right lower lobe ) 

There may also be partial anomalous pulmonary venous return (PAPVR) where the pulmonary veins drain into a structure besides the left atrium and rarely total anomalous pulmonary venous return (TAPVR) occurs where there is no drainage of pulmonary veins into the left atrium.

Related pathology

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Vena pulmonalis:
Arteria
pulmonalis
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