Pulmonary varices are uncommon lesions characterized by localized pulmonary vein dilatation. These abnormalities are uncommon, with just around 100 occurrences documented in the literature. Pulmonary varices are generally identified by chance and can be congenital or acquired; the latter is frequently associated with blockage of the distal pulmonary venous vasculature, hepatic cirrhosis, or mitral valve diseases such as stenosis or regurgitation.
Pulmonary varices might be undetectable on chest radiography or appear as isolated pulmonary nodules, usually around the left atrium. Varices can be identified from pulmonary arteriovenous malformations using thoracic computed tomography, which can show sinuous, serpiginous channels without a vascular nidus and normal-appearing pulmonary arteries. Catheter pulmonary angiography can be used to diagnose pulmonary varices and rule out the possibility of arteriovenous malformations; on the delayed phase of contrast injection, one or more dilated vessels leading to the left atrium opacify similarly to other pulmonary veins, with normal-appearing pulmonary arteries.
Unless varix suddenly grows in size, treatment is typically unnecessary. Unless complications such as hemoptysis, thromboembolic disease, or rupture occur, pulmonary varices are usually asymptomatic, and treatment is rarely required; in this case, treatment is typically directed at the underlying cause of elevated left atrial pressure, though surgical resection may be considered for selected patients.