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The pulmonary veins are the exclusive conduits for returning oxygenated blood from the lungs to the left atrium, a function essential for systemic oxygen delivery. The clinical significance of these blood vessels extends beyond this role due to their complex and highly variable anatomy, which directly influences diagnostic imaging, interventional cardiology, and thoracic surgery. Variations in pulmonary vein number, ostial size, and drainage patterns are common and can substantially affect procedural planning and outcomes, particularly in lung resection, transplantation, and catheter ablation for atrial fibrillation.[1][2] Pulmonary veins are central to the pathophysiology and treatment of atrial fibrillation. Myocardial sleeves extending from the left atrium into the proximal veins serve as frequent sources of ectopic electrical activity. The Heart Rhythm Society underscores the need for detailed anatomical knowledge of the pulmonary veins to enable safe and effective catheter and surgical ablation, given the high prevalence of anatomic variants and the arrhythmogenic potential of these structures. Pulmonary veins are also vulnerable to congenital and acquired diseases, including anomalous pulmonary venous return, stenosis, and thrombosis, each with significant hemodynamic and clinical consequences.[3] Imaging with multidetector computed tomography (CT) and magnetic resonance imaging (MRI) is critical for identifying normal anatomy, anatomic variants, and pathology, and for guiding interventional procedures. The close relationship of the pulmonary veins to adjacent thoracic structures makes them relevant in assessing tumor invasion and mediastinal disease (see Image. Lungs and Mediastinum, Posterior View).[4] Comprehensive knowledge of pulmonary vein anatomy is indispensable for clinicians involved in cardiovascular and thoracic care.