Even though it is a great vein , often the imaging pulmonary veins by echocardiography is a not a pleasant excercise.
This is due to the following facts
- The pulmonary veins are posterior structures
- They occupy the far field of echocardiographic window
- The pulmonary veins often enter obliquely into the LA
- The course of PVs are highly variable ( Like RCA origin !) especially in ASDs ,where identifying PVs becomes all the more important
Hence no fixed imaging angle can be advised . But generally a pattern is observed.
- Right pulmonary veins are best viewed in apical 4 chamber or 5 chamber or in between (Especially RUPV is seen best in 4.5 chamber view !)
- Left pulmonary vein , can be seen in apical 4 chamber but best visualised in Para sternal short axis view.
Other modalities for imaging pulmonary veins
TEE : Can be very useful since it is brings the vein closer to the probe .But needs more expertice.
Contrast echo :Probably a simple and best modality often underutilised.
Very useful to clinch the diagnosis when PVs take abnormal course as in PAPVC .
MDCT , Spiral CT, MRI are the new age modalities that can provide us with dramatic 3d images of PVs.
The echocardiogram will always prevail over these sophisticated gadgets for its simplicity and also it’s ability to give us the physiology of pulmonary venous flow which is vital in many diseases(Constriction, Diastolic function etc)
The following illustration is a gross attempt to simplify the imaging of PVs.Please note the rules may not be applicable in all.
Left upper and lower pulmonary veins in short axis view will be posted shortly .
Reference
The images are based on personal observations and an excellent insight on the topic from Department of Cardiovascular Medicine, Guangdong Provincial People’s Hospital, Guangzhou , China
Dr.S.Venkatesan MD 