A 41-year-old man visited our hospital with the complaint of palpitation by atrial flutter. He was finally diagnosed as total anomalous pulmonary vein drainage by helical computed tomography (CT). This case is very unusual due to the lack of symptoms until the age of 41. The absence of pulmonary artery stenosis, and the presence of atrial septal defect providing sufficient right to left shunt flow to maintain the output of left ventricle are some of the reasons to explain the lack of symptoms and very slight impact on daily life. Helical CT, in particular 3-dimensional imaging, is very useful in diagnosing complicated cardiovascular deformation as in this case.
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