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Right superior pulmonary vein

The right superior pulmonary vein (RSPV) is one of the four main pulmonary veins that return oxygenated blood from the lungs to the left atrium. It drains the right upper lobe (apical, anterior, and posterior segments) and the right middle lobe (lateral and medial segments).

It courses horizontally from the right lung hilum to the posterior left atrium, entering the atrium superior and anterior to the right inferior pulmonary vein. Its ostium is a key anatomical landmark in atrial fibrillation ablation, as ectopic foci frequently arise near pulmonary vein–atrial junctions.

The RSPV has clinical significance in atrial fibrillation, pulmonary vein stenosis (post-ablation), congenital anomalies, and left atrial interventions.

Synonyms

  • RSPV

  • Right upper pulmonary vein

  • Right superior pulmonary venous trunk

Function

  • Returns oxygenated blood from the right upper and middle lobes to the left atrium

  • Maintains normal pulmonary-to-systemic circulation balance

  • Serves as a landmark in electrophysiology procedures (AF ablation)

  • Contributes to left atrial filling and preload for systemic cardiac output

Tributaries

  • Veins of right upper lobe (apical, anterior, posterior)

  • Veins of right middle lobe (lateral, medial)

MRI Appearance

T1-weighted images:

  • Lumen appears as a signal void (black) due to venous flow

  • Vessel wall hypointense, adjacent mediastinal fat hyperintense

T2-weighted images:

  • RSPV lumen appears as a flow void against hyperintense mediastinal fat

  • Thrombosis or stenosis may appear as intermediate/high signal filling defect

T2 TRUFISP (cardiac-gated):

  • Demonstrates RSPV as a bright, well-defined tubular lumen with real-time venous return into left atrium

  • Useful for assessing flow dynamics and patency

STIR (Short Tau Inversion Recovery):

  • Suppresses fat, improving visualization of the vein in mediastinum

  • Perivascular edema or inflammation appears hyperintense

T1 Post-Contrast (Gadolinium-enhanced MRI):

  • RSPV enhances brightly and homogeneously

  • Filling defects represent thrombosis, stenosis, or post-ablation scarring

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

  • Provides 3D reconstruction of RSPV course and left atrial ostium without contrast

  • Useful for pre-ablation mapping, congenital anomalies, and surgical planning

  • Differentiates pulmonary vein ostia and their relationships to the left atrium

MRA (Magnetic Resonance Angiography):

  • Contrast-enhanced MRA delineates RSPV anatomy, ostium size, and variations

  • Essential in AF ablation planning and evaluation of pulmonary vein stenosis

CT Appearance

CT Coronary Angiography (CCTA):

  • Gold standard for pulmonary venous anatomy

  • RSPV visualized as a contrast-opacified vein draining into the superior left atrium

  • Axial, sagittal, and 3D reconstructions show ostial size, branching pattern, and relationship to other pulmonary veins

  • Critical for atrial fibrillation ablation planning, identifying pulmonary vein stenosis, anomalous pulmonary venous return, or thrombus

CT image

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

MRI images

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

MRI images

Right superior pulmonary vein MRI IMAGE