双源CT对先天性心脏病纵隔静脉异常的诊断

目的 探讨双源CT(DSCT)心血管成像对先天性心脏病(先心病)纵隔静脉异常的诊断价值.资料与方法 搜集存在纵隔静脉异常的先心病患者62例,男39例,女23例,年龄17天～29岁.使用Siemens双源CT扫描机扫描,运用多种图像后处理方法,重点观察上腔静脉、头臂静脉、奇静脉、半奇静脉、肺静脉及冠状静脉等有无异常.结果 62例中共存在纵隔静脉异常63处(其中1例同时合并永存左上腔静脉和半奇静脉异常),DSCT均正确诊断,可分为6类:永存左上腔静脉29处,24处经冠状静脉窦汇入右心房,4处直接汇入左心房,1处双上腔静脉分别汇入单心房;左头臂静脉异常15处,包括:主动脉弓下左头臂静脉12处、无名动脉后左头臂静脉1处、食管后左头臂静脉1处、左头臂静脉分为上下2支1处;肺静脉畸形引流15处,包括完全型11处和部分型4处;肺静脉曲张1处,为室问隔缺损并肺动脉高压患儿;无顶冠状静脉窦2处,均为法洛四联症患者;下腔静脉中断并半奇静脉扩张、异常引流入永存左上腔静脉1处.结论 DSCT在先心病纵隔静脉异常的诊断及术前评估中具有重要的应用价值.     

主动脉弓左侧静脉变异的MSCT诊断价值

目的 探讨主动脉弓左侧静脉变异的CT影像特征，提高诊断及鉴别诊断的能力，避免误诊漏诊。方法 选取我院住院患者经彩色多普勒超声心动图及CT共同诊断的18例主动脉弓左侧静脉变异的CT图像。结果 心上型完全型肺静脉异位引流2例，左上肺部分型肺静脉异位引流2例，永存左上腔静脉11例，主动脉弓下左头臂静脉2例，食管后左头臂静脉1例。结论 主动脉弓左侧异常血管断面是心上型完全型肺静脉异位引流、左上肺部分型肺静脉异位引流、永存左上腔静脉、主动脉弓下左头臂静脉、食管后左头臂静脉的共同CT征象，不同的是血管走行，通过此征象可以提高CT对主动脉弓旁先天静脉畸形的诊断水平，避免误诊漏诊。     

左头臂静脉畸形一例

纵隔血管异常相对少见，而左头臂静脉畸形则更为罕见．现报道我院经CT扫描发现1例异常左头臂静脉。     

胎儿永存左上腔静脉和相关先天异常的产前MRI诊断

目的:探讨胎儿永存左上腔静脉和相关畸形的产前MRI表现及MRI诊断价值.方法:12例孕妇,孕龄21～35周.产前常规行超声检查后24～48 h内行MR检查,采用快速平衡稳态采集(FIESTA)序列或平衡稳态梯度回波(B-FFE)序列、单次激发快速自旋回波(SSFSE)序列和非门控动态FIESTA电影序列或实时B-FFE序列,行胎儿颅脑胸腹部常规及胸部重点冠状面、矢状面及横断面扫描、心脏长短轴扫描,将产前MRI、US表现与出生后影像表现、手术或尸解结果对照.结果:12例永存左上腔静脉全部为双侧上腔静脉,其中l例存在桥静脉.在合并相关异常方面其中10例合并心脏畸形、1例合并羊水过少、1例无合并异常.10例合并心脏畸形中4例合并心外异常.对于永存左上腔静脉产前MRI全部准确诊断,产前US准确诊断5例、漏诊7例.对于合并10例心脏畸形,产前MRI准确诊断7例、误诊1例、漏诊2例;产前US准确诊断7例、误诊2例、漏诊1例.结论:产前MRI能准确诊断永存左上腔静脉,对其合并的相关心内异常诊断准确性不如产前超声,对合并的心外异常诊断准确性优于超声.     

产前超声对胎儿永存左上腔静脉的诊断及鉴别诊断

目的探讨产前超声检查在诊断胎儿永存左上腔静脉(PLSVC)中的诊断价值。方法回顾分析24例经我院诊断最后确诊的永存左上腔静脉胎儿的超声图像,总结不同类型的胎儿永存左上腔静脉的超声特点。结果 23例永存左上腔静脉胎儿在出生后经新生儿心脏超声证实。其中10例合并内脏反位,6例单纯PLSVC,10例合并其他畸形(包括1例合并完全性心内膜垫缺损,1例左室发育不全,1例二尖瓣闭锁,2例右位主动脉弓,2例室间隔缺损,1例合并Dandy-Walker畸形,1例肾积水,1例单脐动脉)。漏诊1例。结论产前超声检查对诊断胎儿永存左上腔静脉具有重要的价值,是首选的检查方法。     

下腔静脉畸形的64层螺旋CT表现

目的 探讨64层螺旋CT下腔静脉畸形的影像表现.方法 回顾性分析6986例受检者的腹部64层螺旋CT增强扫描资料,共发现25例下腔静脉先天畸形.分析下腔静脉畸形的影像表现.结果 25例下腔静脉畸形中包括左下腔静脉6例,CT表现为肾下段腹主动脉左侧上行的下腔静脉.双下腔静脉10例,CT表现为肾下段腹主动脉两侧上行的下腔静脉.左肾静脉畸形5例,CT增强扫描横断面显示腹主动脉后和环主动脉走行的左肾静脉.肝下段下腔静脉中断伴奇静脉延续2例,胸腹部CT增强扫描显示肝段至肾上段下腔静脉缺如,肾段下腔静脉由奇静脉延续回流人上腔静脉,而肝静脉直接回流右心房.腔静脉血管造影见对比剂经增粗的奇静脉和半奇静脉通过上腔静脉回流右心房.肝下段下腔静脉中断伴门静脉延续1例,增强CT显示下腔静脉直接与门静脉在肝门部连接,肝门部门静脉呈瘤样扩张.左下腔静脉伴半奇静脉延续1例,增强CT可见左下腔静脉与半奇静脉连接,上行汇入奇静脉.结论 64层螺旋CT可清晰显示下腔静脉及其属支的畸形,可成为下腔静脉畸形的重要诊断方法.     

儿童孤立性永存左上腔静脉合并完全性房室分离1例

永存左上腔静脉(persistent left superior vena cava,PLSVC)是由左前主干静脉退化失败所致,是上腔静脉最常见的畸形,也是最常见的先天性胸腔静脉异常,总患病率为0.35%~0.5%[1-3]。PLSVC伴右上腔静脉缺如(absent right superior vena cava,ARSVC)是一种非常罕见的静脉畸形,称为孤立性PLSVC,发生率为0.09%~0.13%[3]。本文报道1例罕见的儿童孤立性PLSVC,早期诊断为窄QRS波心动过速,经心脏电生理检查明确诊断为房室结功能异常,完全性房室分离伴交界性自主节律、室性心动过速。     

CT增强延时扫描在泌尿系统先天性畸形诊断的价值

目的：探讨CT增强延时扫描在泌尿系统先天性畸形诊断的临床价值。方法：对14例泌尿系统先天性畸形病人(包括肾盏憩室2例，膀胱憩室2例，先天性融合型横过异位合并巨大肾盂1例、肾盂输尿管重复畸形4例，肾盂输尿管交界部狭窄2例，单纯输尿管囊肿3例)行螺旋CT普通扫描、增强扫描和增强延时扫描。结果：CT增强延时扫描能够明确显示憩室内囊液的延迟强化和持续长时间强化；显示发育异常的肾脏、输尿管的结构、位置和功能。结论：CT增强延时扫描在泌尿系统先天性畸形诊断中很有价值，对某些疾病的诊断是十分必要的。     

体静脉连接异常的心血管造影诊断

目的评价心血管造影对体静脉连接异常的诊断价值。方法回顾分析371例经手术证实的体静脉连接异常患儿的心血管造影。结果左上腔静脉残存共190例,其中左上腔静脉回流入冠状窦171例,左上腔静脉回流入左房9例,左上腔静脉经无顶冠状窦回流入左房10例;右上腔静脉缺如3例;下腔静脉异常连接42例,其中40例为下腔静脉中断伴奇静脉回流,1例为下腔静脉回流入左房,1例为双下腔静脉。无名静脉异常共136例。结论体静脉连接异常在先天性心脏病的患者中并不少见,先心病术前通过心血管造影了解体静脉的连接关系对手术有重要的指导意义。     

多层螺旋CT诊断永存左上腔静脉伴右上腔静脉缺如一例

患者男,61岁,因咳嗽1周,于2011年4月来我院就诊.既往无心脏病史.体检未见异常.为明确有无肺部感染而行胸部MSCT检查.CT定位像显示右上纵隔空虚(图1),轴面像显示右侧上腔静脉缺如,主动脉弓和左肺动脉左侧见上下连续的椭圆形软组织密度结节影,边界清晰光整,考虑永存左上腔静脉畸形,遂做增强扫描进一步确诊.应用碘海醇(320 mg I/ml )80 ml以3.O ml/s流率经右侧肘前静脉注射,注药开始15 s后启动CT扫描,于轴面像证实右侧上腔静脉缺如,明显强化的右锁骨下静脉和右颈静脉汇合后经胸骨后间隙横行至左侧,与左侧头臂静脉汇合形成左上腔静脉(图2),沿主动脉弓和左肺动脉左侧下行,中途接受奇静脉血流,然后继续向下向后绕行于左心房和左心室之间的冠状沟,最后经扩大的冠状静脉窦汇入右心房(图3).     

Anomalous left brachiocephalic vein: CT findings.

Eight cases of anomalous position of the left brachiocephalic vein were demonstrated by CT. Six coursed downward lateral to and below the aortic arch to enter the superior vena cava (SVC). Two cases were double left brachiocephalic veins. The superior branch was in the normal position, but the inferior vessel coursed below the aortic arch. Most of these subaortic left brachiocephalic veins enter the SVC at the same level or caudal to the azygous arch. Only two cases were associated with congenital heart disease. This anomalously positioned vessel is asymptomatic but must be distinguished from the pulmonary artery and persistent left SVC, especially when open heart surgery for cardiac malformations is being considered.     

Anomalous pulmonary venous drainage of the left upper lobe shown by CT scans

Isolated anomalous drainage of the left superior pulmonary vein into the left brachiocephalic vein was shown on computed tomographic (CT) scans. The CT findings include a vertical vein lateral to the aorticopulmonary window and aortic arch that terminates in the left brachiocephalic vein. Features that differentiate this entity from left superior vena cava, anomalous left brachiocephalic vein, and superior intercostal vein are discussed.     

Intrapulmonary right brachiocephalic vein associated with azygos lobe

A rare case of right brachiocephalic vein (RBV) following an extramediastinal and intrapulmonary course in the anterior portion of the azygos fissure is presented. The appearance of the RBV and superior vena cava (SVC) on the chest radiograph in patients with an azygos lobe reflects the variable relationship between these veins and their mediastinal attachments. Computed tomography (CT) can easily demonstrate the mediastinal vascular anatomy thereby allowing identification of such variants and differentiation from anomalous pulmonary veins draining into the systemic vein.     

Retro-aortic left brachiocephalic venous trunk. A rare anomaly: 2 cases

Two cases of a rare anomaly of the trajectory of the left brachiocephalic venous trunk were detected by CT scan imaging. In both patients the trunk passed under the aortic arch before emptying into the superior vena cava. One patient presented, in addition, a complex anomaly of the aortic arch.     

The superior vena cava syndrome caused by malignant disease. Imaging with multi-detector row CT

OBJECTIVE: The superior vena cava (SVC) obstruction by malignant diseases is either by direct invasion and compression or by tumour thrombus of the SVC. Whatever is its cause, obstruction of the SVC causes elevated pressure in the veins draining into the SVC and increased or reversed blood flow through collateral vessels. Severity of the syndrome depends on the collateral vascular system development. Therefore, imaging of the collateral veins with variable location and connection is important in determining the extension and management of the disease. Our aims are to describe collateral vessels of the superior vena cava syndrome (SVCS) related with the malignant diseases and to assess the ability of multi-detector row CT with multiplanar and 3D volume rendering techniques in determining and describing collateral circulations. MATERIALS AND METHODS: We present CT angiography findings of seven patients with small cell carcinoma of the lung (n = 2), squamous cell carcinoma of the lung (n = 3), Hodgkin disease of the thorax (n = 1), and squamous cell carcinoma of the oesophagus (n = 1). The patients received contrast-enhanced CT scans of the chest and abdomen on a multi-detector row CT during breath holding at suspended inspiration. RESULTS: CT images revealed the cause and level of the SVC obstruction in all patients with axial and multiplanar reconstructed images. The SVC showed total obstruction in five patients and partial obstruction in two patients. The most common experienced collateral vessels were azygos vein (6), intercostal veins (6), mediastinal veins (6), paravertebral veins (5), hemiazygos vein (5), thoracoepigastric vein (5), internal mammary vein (5), thoracoacromioclavicular venous plexus (5), and anterior chest wall veins (5). While one case showed the portal-systemic shunt, V. cordis media and sinus coronarius with phrenic veins were enlarged in two cases, and the left adrenal vein was enlarged in a patient. In one case, the azygos vein with reversed blood flow was drained into both inferior vena cava and hemiazygos vein with the left renal vein. CONCLUSION: Multi-detector row CT with multiplanar and 3D imaging is an effective tool in evaluation of the SVCS and has a greater advantage than the other imaging techniques. 3D volume rendering is a useful technique in determining and describing collateral circulations in addition to the primary disease process.     

Computed tomography of partial anomalous pulmonary venous connection in adults

OBJECTIVES: To systematically describe the imaging features and clinical correlates of a partial anomalous pulmonary venous connection diagnosed on computed tomography (CT) in adults. METHODS: Twenty-nine adults with a partial anomalous pulmonary venous connection on CT were retrospectively identified. There were 19 women and 10 men, with a mean age of 53 (range: 19-83) years. Four cases were identified by review of 1825 consecutive chest CT reports from July 2000-July 2001, and 25 cases were culled from chest radiology teaching files at 3 institutions. Inclusion criteria were availability of CT images and medical charts. Chest radiographs (25 of 29 cases) were reviewed for mediastinal contour abnormalities, heart size, and pulmonary vascular pattern. Chest CT scans were reviewed for location, size, and drainage site of the anomalous vein; presence or absence of a pulmonary vein in the normal location; cardiac size and configuration; and pulmonary vasculature. Charts were reviewed for evidence of pulmonary and cardiovascular disease, history of congenital heart disease, and results of other cardiac imaging. RESULTS: The prevalence of a partial anomalous pulmonary venous connection was 0.2% (4 of 1825 chest CT reports). Seventy-nine percent (23 of 29 patients) had an anomalous left upper lobe vein connecting to a persistent left vertical vein, only 5% (1 of 23 patients) of whom had a left upper lobe vein in the normal location. Seventeen percent (5 of 29 patients) had an anomalous right upper lobe vein draining into the superior vena cava, 60% (3 of 5 patients) of whom also had a right upper lobe pulmonary vein in the normal location. One patient (3%) had an anomalous right lower lobe vein draining into the suprahepatic inferior vena cava. Chest radiographic findings were abnormal left mediastinal contour in 64% (15 of 25 patients), abnormal right mediastinal contour in 8% (2 of 25 patients), and cardiomegaly in 24% (6 of 25 patients). Computed tomography findings were cardiomegaly in 48% (14 of 29 patients), right atrial enlargement in 31% (9 of 29 patients), right ventricular enlargement in 31% (9 of 29 patients), and pulmonary artery enlargement in 14% (4 of 29 patients). Pulmonary or cardiovascular symptoms were present in 69% (20 of 29 patients), 55% (11 of 20 patients) of whom had specific alternative diagnoses (excluding congestive heart failure and pulmonary hypertension) to explain the symptoms. Only 1 patient (3%) was diagnosed with a secundum atrial septal defect. CONCLUSIONS: A partial anomalous pulmonary venous connection was seen in 0.2% of adults on CT. In contrast to previous series focusing on children, the anomalous vein in adults was most commonly from the left upper lobe, in women, and infrequently associated with atrial septal defects.     

Vena caval and central venous stenoses: management with Palmaz balloon-expandable intraluminal stents.

Palmaz balloon-expandable intraluminal stents (BEISs) were used to treat vena caval and adjacent central venous obstructions that failed to respond to conventional balloon angioplasty. An initial series included seven patients: five had superior vena cava (SVC) syndrome due to a malignant neoplasm and/or radiation therapy, one had dialysis access-related stenosis of the subclavian vein, and one had inferior vena cava (IVC) and bilateral common iliac vein obstruction due to abdominopelvic radiation therapy for Hodgkin disease. Treatment produced clinical benefit in all seven patients. Patency was achieved with stents placed across stenoses of the SVC, IVC, and brachiocephalic and subclavian veins. One stent placed in a left common iliac vein was oval and was shown to be occluded on a follow-up computed tomographic scan, suggesting that compression between the right common iliac artery and the spine was responsible. Although caution is recommended in placement at possible compression sites, BEISs can be used to treat obstructions of the vena cava and major central veins.     

Incidental recognition of left subclavian vein obstruction on renal scintigraphy.

In a renal transplant recipient with persistently poor graft function, the flow phase of a renal scan incidentally revealed multiple venous collaterals with focally increased vascular activity near the left lobe of the liver (quadrate lobe). This was initially assumed to represent superior vena cava (SVC) obstruction. A renal biopsy was contemplated to exclude acute rejection because of a nondiagnostic flow phase (loss of a bolus effect). However, because the possibility of venous obstruction at the level of the subclavian and/or brachiocephalic veins (without involving the SVC) also existed, another renal scan was performed, with injection of radiotracer into the contralateral arm. This showed a patent SVC and reasonably preserved renal perfusion consistent with acute tubular necrosis. Subsequently, left subclavian vein obstruction was identified. The graft function improved with conservative management for acute tubular necrosis. These findings illustrate the danger of considering only SVC obstruction when collateral flow patterns and focal hot spots in the liver are present.     

Anomalous pulmonary venous connection of entire left lung with intact atrial septum.

Three cases of total unilateral pulmonary venous connection of the left lung with intact atrial septum are described. All patients were acyanotic and had findings of volume overload of the right side of the heart. An anomalous vertical vein in the superior mediastinum and large pulmonary arteries were visible on the plain chest radiograph, similar to what is seen in cases of total anomalous pulmonary venous connection. Selective pulmonary angiography delineated the anomalous connection of the left pulmonary veins and documented the absence of an atrial septal defect.     

Three aortic arch anomalies: A review of the literature and proposal of a new classification

Four patients with three rare aortic arch anomalies, all of which can be classified as variants of Edwards' hypothetical double aortic arch system, were studied. The diagnosis was based on angiographic findings in all cases and in addition, on operative findings in three and operative and autopsy findings in one case. All normal and anomalous variants of aortic arches may be incorporated into a new classification based upon Edwards' hypothetical double aortic arch system. In the new classification the term double aortic arch with types A, B, C, or D atresia or interruption of the left or the right arch covers all known arch anomalies. The types A, B, C, and D refer to the site of atresia or interruption of the hypothetical double aortic arch model in relationship to the ductus arteriosus and brachiocephalic vessels.