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Topic

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Left superior pulmonary vein

The left superior pulmonary vein is one of the four main pulmonary veins that return oxygenated blood from the lungs to the left atrium. It drains the left upper lobe of the lung, receiving tributaries from the apical, anterior, and superior lingular segments.

The LSPV courses medially from the hilum of the lung, passing anterior to the left pulmonary artery and superior to the left inferior pulmonary vein, before entering the superior aspect of the left atrium. At its atrial junction, the vein forms part of the pulmonary venous ostia, which are clinically important in atrial fibrillation ablation procedures.

Anatomical variations, such as common trunks with the left inferior pulmonary vein or additional accessory veins, are frequent and clinically significant in electrophysiology and cardiac surgery.

Synonyms

  • LSPV

  • Left upper pulmonary vein

  • Superior left pulmonary vein

Function

  • Returns oxygenated blood from the left upper lobe of the lung to the left atrium

  • Contributes to left atrial filling and systemic oxygen delivery

  • Serves as a landmark for pulmonary venous isolation in atrial fibrillation ablation

  • Provides anatomical reference for cardiac imaging and interventional procedures

Tributaries

  • Apical segmental vein of left upper lobe

  • Anterior segmental vein of left upper lobe

  • Superior lingular vein

MRI Appearance

T1-weighted images:

  • LSPV lumen appears as a signal void (black) due to venous blood flow

  • Surrounded by hyperintense mediastinal and pericardial fat, helping identification

T2-weighted images:

  • Appears as a dark signal void, contrasting with bright background tissues

  • Thrombosis or slow flow may appear as intermediate to high signal

T2 TRUFISP (cardiac-gated):

  • LSPV lumen appears as a bright, well-defined structure

  • Provides dynamic cine evaluation of venous flow into the left atrium

  • Useful in detecting pulmonary venous stenosis or abnormal flow patterns

STIR (Short Tau Inversion Recovery):

  • Fat suppression highlights perivascular pathology

  • Inflammatory or edematous changes around the vein appear hyperintense

T1 Post-Contrast (Gadolinium-enhanced MRI):

  • LSPV lumen enhances homogeneously with contrast

  • Filling defects represent thrombus or post-ablation stenosis

  • Important in MR venography for pulmonary vein mapping

MRI Non-Contrast 3D Cardiac-Gated Imaging (Whole-heart):

  • Provides high-resolution 3D depiction of pulmonary venous anatomy without contrast

  • Clearly visualizes the LSPV ostium and course into the left atrium

  • Crucial for atrial fibrillation ablation planning and congenital anomaly evaluation

CT Appearance

CT Coronary Angiography (CCTA):

  • LSPV visualized as a contrast-enhancing venous channel draining into the left atrium

  • Axial and 3D reconstructions show ostium size, orientation, and variations

  • Best modality for detecting pulmonary venous stenosis, thrombosis, or accessory pulmonary veins

  • Essential in pre-procedural planning for pulmonary vein isolation (PVI) in atrial fibrillation

CT image

Left superior pulmonary vein anatomy CT axial image -img-00000-00000

MRI images

Left superior pulmonary vein anatomy MRI coronal image -img-00000-00000

MRI images

Left superior pulmonary vein mri image