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358 complained of reduced exercise tolerance. Chest X ‐ray confirmed dextrocardia and also showed en‐ larged pulmonary trunk and asymmetric distribu‐ tion of the pulmonary blood flow with increased blood flow in the right lung (Supplementary ma‐ terial, Figure S1). Transthoracic echocardiogra‐ phy (TTE) revealed mildly increased diameter of the right ventricle, right atrial enlargement (area of 24 cm2), and increased diameter of the pulmo‐ nary trunk (29 mm), without other signs of pul‐ monary hypertension. The diameter and function of the left ventricle were normal. Transesophageal echocardiography (TEE) showed a typical return of the left pulmonary veins, while the assessment of the right pulmonary veins was ambiguous. No atrial septal defect was visualized. Chest comput‐ ed tomography (CT) and cardiac magnetic reso‐ nance (CMR) revealed anomalous venous return from the right lung into the IVC, with right lung hypoplasia (Figure 1A and Supplementary materi‐ al, Figure S2). Additionally, the presence of COIC was visualized (Figure 1B and 1C). The right ‐to ‐left shunting ratio (Qp:Qs) was 1.7. Based on the car‐ diopulmonary exercise test, the oxygen uptake was 22.7 ml/min/kg (74% of value according to age and sex). Conservative treatment with fur‐ ther clinical vigilance was chosen. The so ‐called scimitar sign (a curved shad‐ ow resembling a scimitar) is present on chest X ‐rays of fewer than a half of patients with PAPVR,3 therefore multimodality imaging is Partial anomalous pulmonary venous return (PAPVR) is a rare congenital heart defect (prev‐ alence of 1–3/100 000 live births, with a female predominance). It involves abnormal venous re‐ turn from the right lung directly or indirectly to the right atrium, usually to the superior vena cava or, less frequently, to the right atrium or inferior vena cava (IVC). The PAPVR anomaly with venous return directly into the IVC is called scimitar syndrome. Most commonly, PAPVR‐ ‐associated abnormalities include hypoplasia of the right lung and pulmonary artery, and dextro‐ cardia. Since the first report of PAPVR in 1836 and coinage of the term “scimitar syndrome” for its variant by Catherine Neill in 1960, numer‐ ous papers have described this anomaly along with its variations. The developmental errors leading to the scimitar syndrome are not clear‐ ly understood so far. A common origin of the brachiocephalic trunk (the so ‐called innominate artery) and the left common carotid artery, known as the bovine arch, bicarotid trunk, or common brachiocephal‐ ic trunk, is the most common variation of aor‐ tic arch branching, with a prevalence between 7% and 27%.1 The coincidence of PAPVR with a common origin of innominate and carotid ar‐ teries (COIC) has been reported only once so far.2 A 46‐year ‐old man with previously diagnosed scimitar syndrome and dextrocardia was ad‐ mitted to our center for further evaluation. He Correspondence to: Paweł Tyczyński, MD, PhD, Department of interventional Cardiology and Angiology, institute of Cardiology, ul. Alpejska 42, 04-628 Warszawa, Poland, phone: +48 22 343 42 72, email: medykpol@wp.pl Received: October 26, 2020. Revision accepted: February 4, 2021. Published online: February 17, 2021. Kardiol Pol. 2021; 79 (3): 358-359 doi:10.33963/KP.15818 Copyright by the Author(s), 2021 C L I N I C A L V I G N E T T E

Scimitar syndrome and a common origin of the brachiocephalic trunk and left common carotid artery: a unique coexistence