Tubular pulmonary opacities detected at chest radiography: An unusual etiology

Pulmonary varices are rare lesions reflecting localized dilation of one or more pulmonary veins. The etiology of pulmonary varices is unknown, but the lesions may be classified as congenital or acquired. Acquired pulmonary varices are most commonly associated with mitral valve disease, typically valvular stenosis. Other associations include pulmonary artery hypertension, coarctation of the aorta, or pulmonary valve stenosis. Pulmonary varices are usually detected asymptomatically; complications, such as thromboembolic disease or rupture, are rare and are generally unassociated with congenital pulmonary varices. Although pulmonary varices may not be visible at chest radiography, these anomalies may appear as a solitary pulmonary nodule, generally adjacent to the left atrium. Tortuous, serpiginous vessels without a vascular nidus and with normal-appearing pulmonary arteries may be seen in thoracic computed tomography scan in patients with pulmonary varices. Catheter pulmonary angiography has traditionally been used to confidently diagnose pulmonary varices and exclude the presence of arteriovenous malformations - the diagnosis is established by identifying a dilated vessel that leads to the left atrium, opacifying on the delayed phase of contrast injection in a manner similar to other pulmonary veins, in the presence of normal pulmonary arteries. Treatment is unnecessary, unless the vein is rapidly increasing in size. Typically, in the case of acquired pulmonary varices, treatment of the underlying cause for elevated left atrial pressure is the preferred approach.