Euro SCMR, Vienna May 2014 Title: Partial Anomalous Pulmonary Venous Connection with intact atrial septum and right heart dilatation – Comprehensive cardiovascular assessment with multimodality imaging and discussion of possible surgical versus conservative management. Authors affiliations: Heiko Kindler 1 , Rick Wage 2 , Gerard King 1 , John Clarke 1 , Philip Kilner 2 Institution: Eagle Lodge Cardiology 2 , Limerick and Dublin, Royal Brompton Hospital, London 2 Clinical Presentation: A 35 year old man who has been active and well except for recurrent sinusitis, presented with increasing frequency of palpitation. No haemoptysis, cyanosis or ankle oedema. He had a recent chest infection but was otherwise asymptomatic. Clinical examination was unremarkable, biochemistry and haematology unremarkable. Cardiovascular exercise testing: managed 12 minutes of Bruce protocol with no symptoms or significant ECG changes. CMR was performed to determine cause of significant RV dilatation. Initial assessment involved echocardiography, which suggested RV dilatation and mild tricuspid dilatation. No ASD was identified, no areas of right ventricular aneurysmal dilatation or regional hypokinesis were identified, and the patient was referred for CMR. No pulmonary vascular abnormalities were seen echocardiographically. CMR showed anomalous pulmonary venous connection to the brachiocephalic vein with intact atrial septum and significant right heart dilatation. Missed by 3 radiologists. Fig.1 SSFP Cine