Dual connection of single pulmonary vein in partial anomalous pulmonary venous return

We present the case of a 6-month-old infant born premature at 29 weeks with perinatal stroke and postnatal hypoxia. Echocardiogram was suspicious for partial anomalous pulmonary venous return (PAPVR). Cardiac CT showed an unusual variant of PAPVR, with a vertical vein having a dual connection superiorly to the left innominate vein and inferiorly to the morphologic left atrium. This unusual variant has the potential for right-to-left flow with a possibility of systemic hypoxia and paradoxical embolism.