OBJECTIVE: To examine the role and safety of CT angiography in the diagnosis of pulmonary vein anomalies and its impact on the management. METHODS: 41 patients who had CT angiography from July 2007 to October 2008 for the assessment of pulmonary veins were retrospectively reviewed. The indication for the CT angiogram, diagnosis, management and surgical findings were studied. The radiation dose was calculated. RESULTS: Median age is 6 months and median weight is 5 kg. All but 5 required light sedation; only one patient required general anaesthesia. There was no procedure related complication. 11/41 were postoperative patients with persistent respiratory distress including 2 with post repair of pulmonary venous anomaly, and 30/41 were preoperative patients diagnosed to have anomalous pulmonary venous drainage (APVD) on echocardiogram. Of 41 patients, 11 patients had total APVD (4 supracardiac, 3 intracardiac, 3 infracardiac and one mixed type),8 had partial APVD, 10 had hypoplastic pulmonary veins, 2 had pulmonary veins stenosis and 10 were normal. Five TAPVD patients had right and one with partial APVD had left isomerism. 14/31 (45.2%) patients with abnormal pulmonary veins underwent surgical repair and the findings were confirmed at surgery in all patients; 16/31 (51.6%) patients were treated conservatively due to severe associated cardiac lesions in 5, hypoplastic pulmonary veins not amenable to surgery in 11 and in one parents refuse surgical treatment. Mean total radiation dose was 2.5 msev. CONCLUSION: CT angiography is safe and reliable in delinating pulmonary veins pathology which helps in the planning of patients' management.