Infra-cardiac totally anomalous pulmonary venous drainage

We report on a male neonate born at 37 weeks' gestation with severe respiratory distress immediately after birth. The child was cyanosed, requiring high oxygen pressures and continuous positive airway pressure. The pulmonary pattern on the earliest radiographs was difficult to definitively diagnose but, with serial radiographs, it became clear that the radiographic pattern was that of pulmonary venous congestion (pulmonary oedema). However, at no stage during serial radiographs over 8 days was the cardiothoracic ratio (CTR) greater than 60%. This suggested a likely specific diagnosis - infra-cardiac totally anomalous pulmonary venous drainage (TAPVD) with obstruction. An echocardio-gram confirmed an atrial septal defect (ASD) and suggested anomalous pulmonary venous drainage, but the pulmonary veins were incompletely visualised owing to acoustic window limitations. Multidetector computed tomography (CT) of the thorax confirmed infra-cardiac TAPVD with common venous channel obstruction at the oesophageal hiatus. CT was used instead of MRI because of the unstable clinical condition of the patient, enabling rapid diagnosis and minimising time out of the intensive care unit. After the definitive diagnosis was made, surgical correction was attempted. Unfortunately, the patient died of respiratory failure shortly after surgery.