This case report describes an 85-year-old woman with complications resulting from scimitar syndrome, anomalous drainage of the right pulmonary veins into the inferior vena cava. In addition to being the oldest reported case of this congenital anomaly, this is the first report of pulmonary vascular complications from scimitar manifested in the adult. The magnitude of the vascular shunt and advanced nature of the disease precluded surgical or percutaneous intervention in this patient.