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Worsening Dyspnea and New-Onset Atrial Fibrillation in a 79-Year-Old Woman

To identify the key insights or developments described in this article
1 Credit CME

A 79-year-old woman presented with worsening dyspnea on exertion and new-onset atrial fibrillation. A chest radiograph was obtained and demonstrated a vertically oriented pulmonary venous silhouette and elevated right hemidiaphragm (Figure, A). The anomalous pulmonary venous return of the right pulmonary veins into the inferior vena cava resulted in the classic appearance resembling a Scimitar (Turkish sword) on chest radiography.1 These anatomical findings are best visualized on cardiac computed tomography, which has been projected over the chest radiograph (Figure, B).

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Article Information

Published Online: April 5, 2023. doi:10.1001/jamacardio.2023.0367

Corresponding Author: Edward Gerstenfeld, Section of Cardiac Electrophysiology, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143 (edward.gerstenfeld@ucsf.edu).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Midyat  L , Demir  E , Aşkin  M ,  et al.  Eponym—scimitar syndrome.   Eur J Pediatr. 2010;169(10):1171-1177. doi:10.1007/s00431-010-1152-4PubMedGoogle ScholarCrossref
2.
Xiang  J , Wei  S .  Surgical treatment of total anomalous pulmonary venous drainage with atrial fibrillation in an adult: a case report and literature review.   Heart Surg Forum. 2022;25(1):E065-E068. doi:10.1532/hsf.4313PubMedGoogle ScholarCrossref
3.
Clarke  NS , Murthy  R , Guleserian  KJ .  Scimitar syndrome with atrial fibrillation: repair in an adult.   J Thorac Cardiovasc Surg. 2016;152(5):e105-e107. doi:10.1016/j.jtcvs.2016.06.002PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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