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Year : 2017  |  Volume : 34  |  Issue : 1  |  Page : 97-98  

Incidental detection of a curved radiopacity on the chest X-ray

Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication30-Dec-2016

Correspondence Address:
Mandeep Garg
Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-2113.197105

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How to cite this article:
Garg M, Prabhakar N. Incidental detection of a curved radiopacity on the chest X-ray. Lung India 2017;34:97-8

How to cite this URL:
Garg M, Prabhakar N. Incidental detection of a curved radiopacity on the chest X-ray. Lung India [serial online] 2017 [cited 2019 Nov 18];34:97-8. Available from: http://www.lungindia.com/text.asp?2017/34/1/97/197105

   Article Top

A 27-year-old asymptomatic female was referred to our institution with an abnormal chest radiograph obtained as a part of prerecruitment medical screening. The chest radiograph showed curved radiopacity coursing inferomedially along the right cardiac border along with an abnormal right cardiac border (shifted to the right side of chest with increased convexity) and small right lung hilum [Figure 1]. Subsequently, computed tomography of the thorax was done to evaluate these findings. Coronal-reformatted images of the thorax showed curved vascular structure extending from right middle and lower lobes to inferior vena cava (IVC), just above the right hemidiaphragm. In addition, there was narrow caliber of the right pulmonary artery along with hypoplastic right lung. Enlarged right atrium was also seen [Figure 2]a,[Figure 2]b,[Figure 2]c.
Figure 1: Chest X-ray frontal view showing a curved radiopaque shadow coursing inferomedially along the right cardiac border (arrow). In addition, there is abnormal right cardiac border, shifted to the right side with increased convexity (dashed arrow) and small right lung hilum

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Figure 2: Contrast-enhanced computed tomography of the thorax, (a) coronal-reformatted image of the thorax showing abnormal vascular structure (arrow) extending from the right lung to inferior vena cava, joining it just above the right hemidiaphragm. (b) Axial computed tomography image of the upper thorax showing narrow caliber of right pulmonary artery (dashed arrow) along with hypoplastic right lung. Abnormal vascular structure described above is also seen in the cross-section (arrow). (c) Axial computed tomography image of the lower thorax showing enlarged right atrium (dashed arrow) and the abnormal vascular structure in the cross-section (arrow)

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   Question Top

What is the diagnosis?

   Answer Top

Diagnosis is Scimitar syndrome.

   Discussion Top

Scimitar syndrome is described as partial or complete anomalous pulmonary venous drainage of the right lung to the IVC, usually in association with anomalies of the right lung (commonly hypoplasia), pulmonary artery and vein hypoplasia/stenosis, and bronchial abnormalities.[1] A wide spectrum of clinical presentations is seen in these patients. Dupuis et al. divided the patients into two groups: Infantile group, who presents within 1 year of age, and adult group, who present later.[2],[3] Infantile patients present with respiratory insufficiency and cardiac failure while adult patients are usually asymptomatic or present with repeat episodes of infection, minor dyspnea, or hemoptysis.[4]

Scimitar syndrome was named by Neill et al. in 1960.[5] The word “Scimitar” is used to describe this syndrome as the anomalous pulmonary vein of right lung appears as a curved radiopacity along the right cardiac border on chest radiograph, resembling a curved Turkish sword called scimitar.[6] Surgical treatment is only indicated in scimitar syndrome if left to right shunt is significant or severe symptoms and right ventricular dilatation and concomitant cardiac lesions are seen.[7] The type of surgical management to be used is controversial and includes reimplantation of anomalous pulmonary vein into the left atrium, division of abnormal arterial supply of the lung, or partial/complete resection of the right lung.[8] In conclusion, with the increased usage of imaging modalities, scimitar syndrome may be detected incidentally and should be identified. However, it may not require any surgical treatment in an asymptomatic adult with a small shunt.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Najm HK, Williams WG, Coles JG, Rebeyka IM, Freedom RM. Scimitar syndrome: Twenty years' experience and results of repair. J Thorac Cardiovasc Surg 1996;112:1161-8.  Back to cited text no. 1
Dupuis C, Charaf LA, Brevière GM, Abou P. Infantile form of the scimitar syndrome with pulmonary hypertension. Am J Cardiol 1993;71:1326-30.  Back to cited text no. 2
Dupuis C, Charaf LA, Brevière GM, Abou P, Rémy-Jardin M, Helmius G. The adult form of the scimitar syndrome. Am J Cardiol 1992;70:502-7.  Back to cited text no. 3
Karaçalioglu AÖ, Gümüs S, Ince S, Demirkol S. Multimodality imaging in an adult patient with scimitar syndrome. Mol Imaging Radionucl Ther 2014;23:70-3.  Back to cited text no. 4
Neill CA, Ferencz C, Sabiston DC, Sheldon H. The familial occurrence of hypoplastic right lung with systemic arterial supply and venous drainage scimitar syndrome. Bull Johns Hopkins Hosp 1960;107:1-21.  Back to cited text no. 5
Midyat L, Demir E, Askin M, Gülen F, Ulger Z, Tanaç R, et al. Eponym. Scimitar syndrome. Eur J Pediatr 2010;169:1171-7.  Back to cited text no. 6
Brink J, Yong MS, d'Udekem Y, Weintraub RG, Brizard CP, Konstantinov IE. Surgery for scimitar syndrome: The Melbourne experience. Interact Cardiovasc Thorac Surg 2015;20:31-4.  Back to cited text no. 7
Vida VL, Padalino MA, Boccuzzo G, Tarja E, Berggren H, Carrel T, et al. Scimitar syndrome: A European Congenital Heart Surgeons Association (ECHSA) multicentric study. Circulation 2010;122:1159-66.  Back to cited text no. 8


  [Figure 1], [Figure 2]


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