Pulmonary sequestration in the adult. Diagnostic contribution of angiography

PURPOSE: The diagnosis of pulmonary sequestration is based on demonstration of mal-developed lung tissue, feeding on abnormal systemic level. We investigate the role of angiography in the diagnosis of pulmonary sequestration in adult patients. MATERIAL AND METHODS: 1987 to 1998 we examined 9 patients with suspected pulmonary sequestration who were subsequently submitted to surgery. The patients were 3 women and men; 6 of them were symptomatic and 3 asymptomatic. Six patients were examined with CT of chest and upper abdomen, thoracoabdominal aortography and selective arteriography of the abnormal vessel; one patient also submitted to left angiopneumography. One patient underwent bronchography and another one MRI. RESULTS: An unquestionable diagnosis was made in 8 cases, namely 6 of intralobar and 2 of extralobar sequestration, and confirmed surgically. The only questionable case was diagnosed at histology as extralobar pulmonary sequestration atypically fed by thin branches from the left diaphragmatic artery. CONCLUSIONS: Angiography demonstrated the abnormal arterial feeding typical of pulmonary sequestration in all cases but one. The evidence of venous drainage was the key sign to diagnose extra-versus intralobar sequestration. Therefore we conclude that angiography remains an essential tool in the diagnosis of pulmonary sequestration, notwithstanding the great potentials of Helical CT of MR angiography.     

肺栓塞患者64层螺旋CT检查的精心护理

目的确定精心护理在肺动脉栓塞患者接受64层螺旋CT检查或复查中的临床意义。方法2005年12月至2009年1月在我院临床确诊或疑诊肺动脉栓塞85例患者（分别为40例和45例）于64层螺旋CT检杏或复查（包括肺动脉造影和深静脉造影）前后，均得到精心护理。结果造影术前与术中的护理保证了本组患者中肺动脉造影和深静脉造影的成功进行，而术后护理有效地预防和控制了源自上述检查的并发症。结论精心护理在肺动脉栓塞患者的CT检查中，始终起着保驾护航作用。     

Validity of pulmonary cine arteriography for the diagnosis of pulmonary embolism

The aim of this study was to assess the interobserver variations in diagnosis of pulmonary embolism (PE) with cine technique and to compare the diagnostic accuracy of pulmonary arteriograms to final-outcome diagnosis. One hundred and seventy patients with clinical suspicion of acute PE were examined with ECG, laboratory tests, chest X-ray, pulmonary scintigraphy and selective pulmonary cine arteriography. The follow-up time was 6 months. Fifty-one arteriograms were interpreted as positive for PE. Two pulmonary emboli were missed when compared with the diagnosis as stated by the final-outcome committee. No arteriograms were considered as not of diagnostic quality. Mean interobserver agreement in lobar vessels was 100 %, in segmental vessels 93 % and in subsegmental vessels 63 %. The mean interobserver agreement was 89 %. Pulmonary cine arteriography produces high diagnostic accuracy and few inconclusive results in patients with suspected PE. Received: 29 September 1997; Revision received: 9 March 1998; Accepted: 14 July 1998     

Massive hemoptysis from a pulmonary sequestration controlled by embolization of aberrant pulmonary arteries: Case report

A case of massive hemoptysis due to pulmonary sequestration is presented. Initially, the diagnosis of sequestration was unsuspected and bronchial artery embolization was done for management of hemoptysis from the left lower lobe, but 4 days later massive hemoptysis recurred. Repeat arteriography, including a thoracoabdominal aortogram, revealed two large abdominal arteries penetrating the left diaphragm and feeding the lower lung. Embolization of the aberrant artery from the celiac trunk and the left inferior phrenic artery resulted in complete hemostasis until elective surgical ligation of the two arteries was performed 2 months later. The massive hemoptysis from a pulmonary sequestration could only be controlled after embolization of the transdiaphragmatic aberrant pulmonary arteries.     

Modified technique for percutaneous transfemoral pulmonary angiography

Percutaneous transfemoral pulmonary arteriography was easily performed in 175 patients with a newly modified Grollman catheter developed to facilitate catheter passage through the tricuspid valve without a tip deflector. No significant catheter-related complications occurred. This simple technique allowed rapid and safe access to the pulmonary arteries.     

双源CT双能量肺灌注成像对肺栓塞的诊断和临床应用价值

目的:探讨双源CT双能量肺灌注成像对肺动脉栓塞的诊断和临床应用价值。方法:对疑诊肺动脉栓塞的78名患者行双源CT肺动脉成像双能量扫描,数据经后处理得到肺动脉血管图像(CTA)和肺灌注图像(PBV)。两位医师对PBV图像进行质量评价和分型,同时观察CTA图像有无栓塞以及栓塞的部位、程度。分析PBV图像的表现与CTA图像、肺部异常改变的关系。用Kappa系数检验两位观察者对PBV图像质量评价和分型的一致性,计算PBV图像诊断肺栓塞的敏感度、特异度、阳性预测值和阴性预测值。结果:两位医师对肺灌注图像质量的分级以及肺灌注图像的分型一致性极强,K值分别为0.87、0.80,P值均<0.01。PBV图像诊断肺栓塞的敏感度为95.30%,特异度为56.40%,阳性预测值为70.70%,阴性预测值为91.20%。对于完全栓塞的患者,其敏感度和特异度均为100%。结论:双源CT双能量肺灌注成像能够显示肺动脉栓塞导致肺血流改变的肺灌注异常。     

多层螺旋CT在诊断肺隔离症中的应用

目的 评价多层螺旋CT血管成像对肺隔离症的诊断能力。方法 15例经病理（14例）和血管造影（1例）证实的叶内型肺隔离症患者均经多层螺旋CT平扫与增强扫描，并采用容积再现技术，最大密度投影及多平面重建显示异常血管与病灶的关系。结果 15例肺隔离症患者中，14例的病灶位于左下叶，1例的病灶位于右下叶，异常体动脉供血全部来自胸主动脉，其平均直径1．6cm。CT平扫表现为肿块形7例，圆形或卵圆形5例，不规则形3例。增强后15例均显示异常体动脉供血。结论 多层螺旋CT血管成像技术能准确诊断肺隔离症，并可取代其他有创性检查，如数字减影血管造影等。     

叶内型肺隔离症致咯血的栓塞治疗

目的探讨叶内型肺隔离症患者咯血的栓塞治疗效果。方法结合文献复习，回顾性分析6例叶内型肺隔离症患者血管造影表现，并对畸形动脉行栓塞治疗。结果6例叶内型肺隔离症患者血管造影显示畸形动脉7支，表现为粗大、迂曲的体循环血管影；在毛细血管期可见隔离肺叶染色及引流静脉早显；静脉期显示引流静脉（肺静脉）。6例患者均进行畸形血管栓塞治疗，临床止血总有效率100％，随访1a均未复发。结论畸形血管栓塞术对叶内型肺隔离症致咯血的治疗，安全有效。     

Subselective magnification angiography of experimental pneumonia

An experiment was designed to determine whether or not acute pneumococcal pneumonia in dogs is associated with intravascular thrombosis, or with angiographic features distinguishable from pulmonary embolism. In dogs with normal baseline chest radiographs and perfusion scans, pneumonia was produced by transbronchial instillation of type III pneumococcus. After 2 days, perfusion scans demonstrated discrete appropriate defects. In vivo magnification pulmonary arteriography, postmortem pulmonary arteriography, and histologic examination disclosed no evidence of thrombi.     

64层螺旋CT双期血管成像在肺隔离症术前评估中的应用

目的：探讨64层螺旋CT双期血管成像在肺隔离症术前评估中的应用价值。方法：12例肺隔离症患者均行双期CT血管成像（cTA）,将原始扫描数据行容积再现（VR）、最大密度投影（MIP）、薄层最大密度投影（TSMIP）重建,观察血管情况及肿块与供血动脉的关系。结果：12例肺隔离症患者11例为叶内型,1例为叶外型。左肺下叶后基底段9例,右肺下叶后基底段3例。囊性肿块6例,囊实质性肿块4例,实质性肿块2例。12例患者共发现12支供血动脉,分别发自胸主动脉（9支）、腹主动脉上段（2支）、腹腔干（1支）,静脉引流均为肺静脉。CTA可清楚显示肺隔离症肿块形态、血管及周围组织的关系。结论：双期CTA扫描结合不同后处理成像方式为肺隔离症术前评估提供了重要的资料,可在临床推广应用。     

Entanglement of a pigtail catheter by the chordae tendineae of the tricuspid valve during pulmonary angiography

Two cases are presented in which a pigtail catheter was entrapped by the chordae tendineae of the tricuspid valve during pulmonary arteriography. A technique for removal of the catheter from its entanglement by the chordae tendineae is described. Caution must be taken when advancing through the right ventricle a catheter that appears to be entrapped by the chordae tendineae. When such an entanglement occurs, measures to reduce the risk of rupturing a papillary muscle must be taken.     

Acute pulmonary embolus mimicked on V/Q scan by sarcoidosis

Acute pulmonary embolus is a common problem requiring evaluation in the emergency setting. Following the initial chest radiograph, the most common imaging test requested is the ventilation perfusion lung scan. We describe a patient with sarcoidosis and a false positive ventilation perfusion lung scan caused by bilateral hilar adenopathy compressing the proximal pulmonary arteries. This case illustrates that patients with hilar adenopathy and suspected pulmonary embolus may have unreliable ventilation perfusion scans, and should be referred to arteriography or CT for evaluation, rather than for a ventilation perfusion lung scan.     

Panvenography and pulmonary angiography in the diagnosis of deep venous thrombosis and pulmonary thromboembolism

In summary, high-quality pulmonary angiography remains the most accurate and reliable means of diagnosing pulmonary embolism. It can be performed with relative safety, and the inherent mortality risks with pulmonary angiography (in the range of 0.2 to 0.5 per cent in active angiography laboratories) must be weighed against the significant risks incurred with inaccurate diagnosis obtained without pulmonary arteriography. Pulmonary arteriography and transvenous catheter embolectomy can be of great benefit in sudden cardiovascular collapse due to massive pulmonary embolism. Transvenous catheter embolectomy has survival rates at least as good as those of open embolectomy, and it has the advantage that it can be performed in any hospital with angiographic facilities and trained personnel, thus allowing more expeditious management of massive pulmonary embolism in hospitals that do not have cardiopulmonary bypass capabilities.     

肺动静脉畸形的影像诊断(附18例分析)

目的：探讨肺动静脉畸形PAVMs相关影像检查方法的诊断价值。方法：回顾分析18例PAVMs的影像学表现，其中9例经手术病理证实，9例临床表现典型并经相关影像检查确诊。结果：18例PAVMs中，单发病灶11例，双发病灶2例，多发病灶5例。18例行X线检查，诊断符合率为72．2％；CT平扫7例，诊断符合率为85．7％；5例肺动脉造影，诊断符合率为100％。结论：瘤样扩张的血管囊腔与其相连的供血动脉和引流静脉血管为PAVMs的其本构筑，X线检查与CT平扫对征象典型的病例可作出诊断，对征象不典型和多发性病变诊断有限度。肺动脉造影是检查和诊断本病的金标准，能为手术治疗提供可靠的指征。螺旋CT增强扫描和三维重建是诊断PAVMs理想和无创伤的影像检查方法。     

Radionuclide pulmonary arteriography

Radionuclide pulmonary arteriography offers a unique method for visualizing the main pulmonary artery and its major branches. Since the radioactive particles that are injected intravenously become lodged in the pulmonary capillaries and pre-capillary arterioles, there is no interference from the systemic circulation. Normally, the main pulmonary artery is visualized for no longer than 4 or 6 seconds; prolongation of the duration of visualization may be indicative of, for example, pulmonary hypertension and pulmonary embolism. The patency of the left and right pulmonary arteries may be determined and sites of occlusion identified.     

Angiography of pulmonary emboli: digital studies and balloon-occlusion cineangiography

The value of digital pulmonary arteriography and balloon-occlusion cineangiography was investigated in 118 selected patients. In one series of 40 patients, digital pulmonary arteriography correctly identified pulmonary emboli in 20 (75%) of 26 positive examinations when interpretation was confined to the first three divisions of the pulmonary artery. In a second series of 78 patients with peripheral radionuclide perfusion scan defects, 40 of whom had pulmonary emboli, adjunctive balloon-occlusion cineangiography demonstrated emboli in four patients not seen on standard selective catheter pulmonary magnification studies with cut films. These two procedures (i.e., digital pulmonary arteriography and balloon-occlusion cineangiography) are important adjuncts to radionuclide perfusion scans and selective catheter pulmonary arteriography in the evaluation of patients with pulmonary emboli.     

Intralobar pulmonary sequestration: MR evaluation

This report documents the use of magnetic resonance (MR) in evaluation of intralobar pulmonary sequestration. Because of its distinctive multiplanar capabilities and nonreliance on contrast media to visualize blood vessels, MR can be used to define and characterize the size and course of anomalous arterial feeding vessels. Furthermore, MR can be of value in detecting the presence of mucoid-impacted bronchi within abnormal segments of the lung. It is concluded that in select cases MR may obviate the need for more invasive procedures to establish the diagnosis of pulmonary sequestration.     

Unusual pulmonary angiographic findings in suspected pulmonary embolism

Pulmonary arteriography is most commonly performed to diagnose pulmonary embolism. A variety of clinical entities, however, may mimic pulmonary embolism both clinically and scintigraphically. Five patients with abnormal pulmonary arteriograms resulting from diseases other than pulmonary embolism are presented. The clinical, radiographic, and pathologic findings and long-term follow-up in these patients are described. Awareness of the angiographic patterns seen in these unusual cases is important in the differential diagnosis of pulmonary thromboembolism.