Total anomalous pulmonary venous return with obstruction to the venous pathway is a life-threatening emergency. We report a neonate with unusual infradiaphragmatic drainage into the ductus venosus and gastric veins. Neonatal gastric varices with obstructed pulmonary venous return are extremely rare with potential for catastrophic gastrointestinal haemorrhage. The complex anatomy first detected by echocardiography was clarified on CT.
Keywords: TAPVR; gastric varices; obstructed pulmonary veins; total anomalous pulmonary venous return.