Anomalous lobar pulmonary vein resembling pulmonary arteriovenous malformation

We present a case report of a 72-year-old man with an anomalous lobar pulmonary vein which was initially misdiagnosed as a pulmonary arteriovenous malformation on chest computed tomography. This uncommon condition was correctly diagnosed during pulmonary angiography performed as workup for the computed tomography finding. In this report, we describe the imaging findings in this case and discuss congenital anomalies of the pulmonary veins.     

A case of pulmonary varices in which enhanced CT was useful for diagnosis]

A case of pulmonary varices in a 73-year-old female is presented. Routine chest X-ray revealed a mass in the right hilar region. CR tomogram showed a round, clearly defined mass at the right hilum. Computed tomography demonstrated marked enlargement of the proximal portion of the pulmonary vein at the entrance of the left atrium, which was suspected to be pulmonary varices. The diagnosis was confirmed by pulmonary angiography. During the arterial phase no abnormal findings were seen, but during the venous phase the veins of the right upper and middle lobes were found to be draining into the dilated pulmonary vein and then into the left atrium. Thus, the diagnosis of pulmonary varices was established. CT and angiography are the most useful methods for definitive diagnosis of pulmonary varices.     

Intravascular sarcoidosis presenting as pulmonary vein occlusion: CT and pathologic findings

It is well known that destruction of the distal capillary bed from extensive fibrosis and honeycombing in the setting of sarcoidosis may lead to pulmonary hypertension. However, we report an unusual manifestation of sarcoidosis where pulmonary hypertension resulted from granulomatous involvement of the pulmonary veins and venules. This presented as venous occlusion and intraluminal filling defects that simulated thrombus on chest computed tomography. To our knowledge, this is the first reported imaging case of such a presentation.     

Anomalous isolated segmental pulmonary vein dilatation detected by computerized tomography of the chest

This report presents findings detected on computerized tomography of the chest in three patients with dilatation of a segmental pulmonary vein and its branches. Each patient had dilatation of an isolated segmental pulmonary vein and its branches with a normal distribution, and no associated cardiovascular anomalies; in two patients, ground glass opacity corresponding to the distribution of the dilated pulmonary veins was observed. The CT features are consistent with a rare subtype of congenital pulmonary varix.     

Evaluation of diagnostic accuracy of computed tomography to assess the angioarchitecture of pulmonary sequestration

Bronchopulmonary sequestration is an unusual congenital malformation consisting of abnormal lung tissue that lacks normal communication with the tracheobronchial tree. The diagnosis of pulmonary sequestration is based on identifying this systemic arterial supply. We aimed to evaluate the sensitivity of multidetector computed tomography in demonstrating the feeding artery and draining veins. Between 2003 and 2008, 8 patients (6 males, 2 females) ranging in age from 5 to 49 years with a diagnosis of pulmonary sequestration were identified. All patients underwent evaluation with chest tomography (spiral or multi detector tomography) and digital subtraction angiography. Aberrant systemic arterial supply was demonstrated in all cases: from the descending thoracic aorta (n= 6); arcus aorta (n= 1), internal mammarial artery (n= 1), intercostal arteries (n= 2) and celiac axis (n= 1). Four patients underwent surgery which confirmed the angioarchitecture depicted on angiography. One patient underwent angiography with embolization using. Computed tomography especially multidetector computed tomography is a powerful noninvasive technique for the detection of pulmonary sequestration.     

A rare case of dilatation of pulmonary veins and pulmonary emphysema in both lower lobes

A 34-year-old man was admitted to hospital because of persistent shortness of breath and diffuse vascular dilation at both lower fields of his CXR. Bronchiectasis had been suspected during childhood because of abnormal chest shadows. However, a chest CT scan obtained on admission failed to show bronchiectasis, but rather there was a dilation of blood vessels and low attenuation areas in both lower lobes. A pulmonary angiogram showed normal pulmonary arteries in the arterial phase and diffuse dilated veins in the venous phase. Although the patient also had liver cirrhosis type B with portal hypertension, no association could be found between his liver cirrhosis and the lung lesions. This is a rare case of possible congenital or idiopathic diffuse dilatation of the pulmonary veins.     

Acute pulmonary thromboembolism associated with interstitial pneumonia

A 68-year-old woman, who had been diagnosed as idiopathic interstitial pneumonia, complained of progressive dyspnea on exertion for a week. Although her chest radiograph did not worsen, arterial blood gas findings were markedly worsened. Contrast-enhanced chest computed tomography showed filling defects of the right upper and middle lobe branches of the pulmonary artery. She was diagnosed as having acute pulmonary thromboembolism (APTE). Clinical symptoms and contrast-enhanced chest computed tomography findings were remarkably improved after the treatment with heparin and urokinase. APTE should be considered as a differential diagnosis in patients with interstitial pneumonia who have worsening of respiratory symptoms with unchanged chest radiograph.     

Traumatic pulmonary pseudocysts: CT findings

Traumatic pulmonary pseudocyst constitutes an uncommon, though well recognized, manifestation of closed chest trauma. It is usually encountered in young patients, whose compliant chest wall permits the transmission of great compressive forces to the lung parenchyma and the laceration of the latter. Traumatic pulmonary pseudocyst is usually detected during the imaging evaluation of multi-injured patients with the use of computed tomography, as it is often not apparent in the initial supine anteroposterior chest radiographs. We present 5 cases of trauma patients, in whom we detected the presence of multiple traumatic pulmonary pseudocysts during the imaging evaluation of blunt chest trauma with the use of computed tomography.     

Echocardiographic diagnosis of pulmonary vein varix.

Pulmonary vein varix is a rare abnormality, often resembling a pulmonary or mediastinal mass on chest radiographs, and pulmonary angiography has been the mainstay of diagnosis. An unusual case of pulmonary vein varix was clearly defined by echocardiography performed in a 47-year-old woman with chest discomfort who had been found to have an abnormal structure behind the cardiac silhouette on a chest radiograph. The diagnosis of left lower pulmonary vein varix was noninvasively confirmed by transthoracic echocardiography and transesophageal echocardiography.     

A rare case of marked dilatation of the pulmonary veins and emphysematous lesions in both lower lung lobes]

A 34-year-old man was admitted to our hospital because of continuous shortness of breath and abnormal chest shadows. Bronchiectasis had been suspected because of abnormal chest shadows during childhood. However, a chest CT scan obtained on admission did not show any bronchiectatic changes, but marked dilated blood vessels and emphysematous changes in the bilateral lower lobes were seen. A pulmonary angiogram showed normal pulmonary arteries in the arterial phase and diffuse dilated veins in the venous phase. Although he has been suffering also from liver cirrhosis type B with portal hypertension, we could not find any association between the liver cirrhosis and the lung lesions. This is a very rare case in which there is a possibility of congenital or idiopathic dilatation of the pulmonary veins.     

CT of the pulmonary veins

Atrial fibrillation (AF) is a common cardiac rhythm disturbance and its incidence is increasing. Radiofrequency catheter ablation (RFCA) is a highly successful therapy for treating AF, and its use is becoming more widespread; however, with its increasing use and evolving technique, known complications are better understood and new complications are emerging. Computed tomography (CT) of the pulmonary veins, or more correctly, the posterior left atrium (LA), has an established role in precisely defining the complex anatomy of the LA and pulmonary veins preablation and has an expanding role in identifying the myriad of possible complications postablation. The purposes of this article are: to review AF and RFCA; to discuss CT evaluation of the LA and pulmonary veins preablation; and to review the complications of RFCA focusing on the role of CT postablation.     

Invasive pulmonary haemangiomatosis

Invasive pulmonary haemangiomatosis is a recently described disease in which exceedingly thin-walled vessels of capillary or venous dimensions infiltrate the lung parenchyma and pulmonary blood vessels. The angiomatous vessels, of obscure origin, infiltrate the media and intima of muscular pulmonary arteries, pulmonary veins and venules. The occlusion of the veins and venules by the thin-walled vessels, and the reactive intimal fibrosis they provoke, leads to pulmonary capillary dilatation, collections of intra-alveolar siderophages, fibrosis of alveolar walls and osseous nodules. This secondary pulmonary veno-occlusive disease in turn leads to hypertensive pulmonary vascular disease. Hence invasive pulmonary haemangiomatosis represents a fourth cause of 'unexplained pulmonary hypertension', the other three being unexplained plexogenic pulmonary arteriopathy, recurrent pulmonary thromboembolism, and pulmonary veno-occlusive disease. Two previously reported cases of invasive pulmonary haemangiomatosis presented with recurrent haemoptysis and the gradual development of chronic respiratory insufficiency associated with diffuse infiltrates in the chest radiograph. In one of these cases a haemothorax had developed. Such clinical features may be of importance in coming to the correct diagnosis.     

肺静脉内膜剥脱术治疗小儿先天性肺静脉狭窄

目的 分析先天性肺静脉狭窄患儿的临床特点,探讨肺静脉内膜剥脱术治疗小儿先天性肺静脉狭窄的疗效.方法 回顾性分析2008年1月至2009年12月收治的4例先天性肺静脉狭窄患儿的临床资料,其中男3例,女1例,年龄2个月～2岁11个月.均行胸片、心电图和超声心动图检查,其中2例行心脏多排计算机断层扫描检查,以期明确诊断.4例患者共有7支肺静脉狭窄,右上肺静脉3例,右下肺静脉1例,左上肺静脉1例,左下肺静脉2例.狭窄部位均在肺静脉开口处,均合并其他心血管畸形：室间隔缺损3例,房间隔缺损1例,动脉导管未闭2例,主动脉缩窄1例,术前均提示重度肺动脉高压.术前根据病情予强心、利尿、扩血管及抗感染等治疗.完善术前准备后在全身麻醉、胸骨正中切口、深低温、体外循环下行肺静脉内膜剥脱术.结果 术后患儿血流动力学稳定;机械通气时间3.7（2～4）d,重症监护时间4.2（3～5）d;围术期无一例死亡.随访18～26个月,患儿均存活,心功能（纽约心脏协会）Ⅰ级3例、Ⅱ级1例,生长发育均正常.结论 先天性肺静脉狭窄常合并各种心内畸形,超声心动图、心脏多排计算机断层扫描检查对诊断帮助较大.肺静脉内膜剥脱术治疗先天性肺静脉狭窄患儿安全、有效,手术成功率高,近期随访疗效较好,对于婴幼儿先天性肺静脉狭窄不失为一种治疗选择.     

Total anomalous pulmonary venous connection: helical computed tomography as an alternative to angiography

BACKGROUND: Echocardiographic evaluation of the pulmonary veins is inadequate at times. Cardiac catheterization, especially in sick neonates, may be a high-risk procedure. Helical computed tomography with three-dimensional reconstruction is noninvasive but remains an underutilized modality. METHODS AND RESULTS: Between January 2002 and February 2003, 7 computed tomography scans of children 3 weeks to 5 years of age were performed to evaluate the drainage of the pulmonary veins in suspected total anomalous venous drainage. Helical computed tomography (GE High speed Advantage) was performed using 2 mm sections, and rapid bolus hand injections of 2 ml/kg body-weight of nonionic intravenous contrast. Sagittal and coronal reformats, and three-dimensional reconstructions were performed, and reviewed by the radiologist. The findings were discussed with the pediatric cardiologist and surgeon involved in the case. The diagnoses included complex congenital heart disease (n = 5), isolated infradiaphragmatic total anomalous pulmonary venous connections (n = 1), and transposition of the great arteries with total anomalous pulmonary venous connections (n = 1). Cardiac computed tomography accurately demonstrated infradiaphragmatic total anomalous pulmonary venous connections in 4, and supracardiac drainage in 3 patients, in addition to the other cardiac findings. The findings on computed tomography scan correlated with surgical (n = 5) and/or angiographic findings (n = 2) in 7 patients. CONCLUSIONS: In sick, high-risk patients, cardiac computed tomography can be considered as an alternative to cardiac catheterization for the evaluation of pulmonary venous drainage.     

Pulmonary varix mimicking pulmonary arteriovenous malformation in a patient with Turner syndrome

A 36-year-old asymptomatic female with Turner syndrome was referred for a 3-cm opacity of the left lung detected by routine chest X-ray. A computed tomography scan of the chest suggested a vascular lesion such as pulmonary arteriovenous malformation, and transcatheter embolotherapy was considered. The lack of a right-to-left shunt on contrast echocardiography led to suspect an alternate diagnosis. Magnetic resonance imaging and pulmonary angiography eventually demonstrated a pulmonary varix associated with a partial anomalous pulmonary venous return. Contrast echocardiography may help to distinguish between pulmonary varix and arteriovenous malformation.     

Risk stratification of acute pulmonary embolism

Acute pulmonary embolism (PE) is a potentially life-threatening condition, with an overall 3-month mortality rate of 15% and with right ventricular failure as the most common cause of early death. Risk stratification facilitates identification of high-risk patients and may be helpful in guiding the initial and long-term management. In patients with massive PE and hemodynamic instability, rapid risk assessment is paramount and bedside echocardiography and multislice chest computed tomography (CT) are useful for identifying patients who may benefit from thrombolysis or embolectomy. Cardiac biomarkers, including troponin and the natriuretic peptides, are sensitive markers of right ventricular function. Low levels of troponin, B-type natriuretic peptide (BNP), and NT-terminal proBNP are all highly sensitive assays for identifying patients with an uneventful clinical course. Multislice chest CT is not only useful to diagnose or exclude PE; it also is useful for risk assessment. A right-to-left ventricular dimension ratio > 0.9 on the reconstructed CT four-chamber view identifies patients at increased risk of early death. This article focuses on risk stratification tools, including the clinical examination, electrocardiography, echocardiography, cardiac biomarkers, and chest CT.     

Asymmetric pulmonary perfusion causing unilateral pulmonary edema as a complication of acute myocardial infarction

Acute unilateral pulmonary edema is an unusual clinical condition occasionally associated with severe mitral valve insufficiency. We describe a patient diagnosed as having unilateral pulmonary edema after an acute anterior myocardial infarction. Echocardiograms performed in the acute phase ruled out mitral insufficiency. A perfusion lung scan showed left-sided pulmonary hypoperfusion. The diagnosis of acquired hypoplasia of the left pulmonary artery tree was made by chest computed tomography. The pathogenesis and differential diagnosis are discussed.     

Isolated pulmonary vein atresia

Two patients with isolated atresia of the pulmonary veins are described. One patient presented with haemoptysis and the other with recurrent unilateral chest infections. The diagnosis was confirmed in both instances by cardiac catheterisation and pulmonary angiography. One patient died one year after the diagnosis was made and the second child has been stable during a follow up period of three years.     

Mediastinal lung herniation associated with pulmonary sequestration

Mediastinal lung herniation is a rare condition characterized by protrusion of 1 lower lung through behind the heart into the opposite side of the chest, usually from right to left. We present a case of mediastinal lung herniation associated with pulmonary sequestration, which was confirmed both surgically and pathologically in a 13-year-old girl initially admitted with a diagnosis of pneumonia. Contrast-enhanced computed tomographic images using a multidetector-row computed tomography clearly demonstrated the right lung herniation toward the left and 2 aberrant systemic arteries supplying the sequestered lung mass. These arteries run through the herniated lung from right to left. Additionally, on the basis of pleural anatomy, we discuss herein the difference between a mediastinal lung herniation and horseshoe lung.     

Bilateral proximal pulmonary artery aneurysms simulating hilar adenopathy.

Proximal pulmonary artery aneurysms (PAAs) are rare. Most are associated with secondary pulmonary hypertension or a variety of rare systemic disorders. An asymptomatic adult patient presented with bilateral hilar enlargement on a routine chest roentgenogram. Computed tomography of the chest revealed 5 cm bilateral proximal PAAs with a normal pulmonary trunk. The clinician should consider proximal PAA in the differential diagnosis of hilar enlargement.