Total Anomalous Pulmonary Venous Drainage into the Left Innominate Vein Associated with Transposition of the Great Vessels

The diagnosis of a patient with total anomalous pulmonary venous drainage into the left innominate vein associated with transposition of the great vessels is described. It is suggested that the characteristic "cottage-loaf" cardiovascular shadow is absent because transposition of the great vessels leads to pulmonary oligemia, in contrast with the increased pulmonary blood flow that is present when the great vessels are not transposed with this type of abnormal pulmonary venous drainage.