Infra-diaphragmatic total anomalous pulmonary venous drainage presenting with rectal bleeding

A boy aged 1 month presented with profuse rectal bleeding. Chest x-ray film showed pulmonary oedema and at cardiac catheterisation infradiaphragmatic total anomalous pulmonary venous drainage to a dilated portal venous system was found. Ulcerated oesophageal varices were identified at necropsy after unsuccessful cardiac surgery. The late and unique presentation of this case is emphasised.