Anomalous origin of the right coronary artery from the pulmonary artery

Anomalous origin of the right coronary artery from the pulmonary artery was diagnosed by selective left coronary artery angiography in an asymptomatic five-year-old boy with a continuous murmur. The anomalous coronary artery, along with a cuff of the pulmonary artery, was re-implanted into the aorta. The patient is asymptomatic five years postoperatively.     

肺癌支气管动脉造影征象与病理分型相关性研究

目的探讨肺癌支气管动脉造影征象与病理的分型相关性。材料与方法本组63例患者均经术前活检或术后病理证实,其中鳞癌32例,腺癌15例,大细胞未分化癌12例,小细胞未分化癌4例。全部病例均成功地进行了规范化的支气管动脉造影,同时采用国际抗癌联盟提出的TNM分期标准分期;其中Ⅱ期6例、Ⅲa期12例、Ⅲb期17例、Ⅳ期28例。结果(1)瘤体多血供型43例,包括全部15例腺癌、4例小细胞未分化癌以及11例大细胞未分化癌,13例低分化鳞癌。(2)瘤体少血供型20例,包括19例鳞癌及1例大细胞未分化癌。结论(1)支气管动脉造影所表现的血供特征,在鉴别病理类型方面有重要价值。(2)支气管动脉造影对肺癌的TNM分期亦能提供一定程度的科学依据。     

The radiographic appearance of coronary artery dissection: A decision-making dilemma

The appearance of acute iatrogenic dissection of the coronary arteries during coronary angiography is described in five patients. Specific signs of dissection include: 1) intimal flap, 2) delayed flow, 3) loss of side branches, 4) periostial contrast “puddling,” and 5) unusually small size coronary artery with atypical smooth walls. Recognition of the radiographic patterns of this complication should permit distinction from coronary spasm, thrombosis, and embolization. Recent advent of alternate forms of therapy (streptokinase infusion, angioplasty) makes it imperative to precisely diagnose the dissection to avoid possible catastrophic results.     

Pulmonary arteriography: The importance of multiple projections

Pulmonary arteriography is a highly specific procedure for the diagnosis of vascular abnormalities within the lungs. However, no single projection canalways be diagnostic for abnormalities in any of the pulmonary arteries. We emphasize the anatomic basis for the initial projection on pulmonary arteriography, as well as the necessity for further studies in different projections if the first study demonstrates no abnormality.     

Congenital absence of the pulmonary valve

Congenital absence of the pumonary valve (CAPV) is a rare anomaly usually associated with ventricular septal defect or Fallot's tetralogy. CAPV may be rapidly fatal in infancy because of severe disturbance of pulmonary ventilation resulting from bronchial compression by massively dilated pulmonary arteries. Other cases may be relatively benign. Our group of five cases with CAPV ranged from the severe to one case in which there was documented closure of a patent ductus artierosus and a ventricular septal defect, leaving the CAPV as an apparently isolated, well-tolerated lesion. Plain chest radiographs play a major part in the diagnosis of CAPV since they almost invariably give some indication of the aneurysmal dilatation of pulmonary arteries. On angiography, dilated main pulmonary arteries are shown giving rise to branches of normal or even diminished caliber.     

螺旋CT肺动脉造影对于肺动脉栓塞的诊断价值(附8例报告)

目的评价螺旋CT肺动脉造影对于肺动脉栓塞的诊断及随访观察溶栓疗效的可靠性和准确性。方法经我院螺旋CT肺动脉造影诊断的8例肺动脉栓塞患者中有5例进行溶栓治疗。结果8例患者共有17处肺动脉及分支受累。动脉栓子呈偏于管腔一侧的突起状、不规则状和位于管腔中心的柱状及完全堵塞状态。5例溶栓治疗后有3例栓子完全消失，2例栓子明显缩小。结论螺旋CT肺动脉造影在诊断肺动脉栓塞和治疗随访观察疗效过程中都有着重要的价值，可望成为肺动脉栓塞诊断的首选方法。     

MR angiography in the diagnosis of extralobar pulmonary sequestration: a case report

We report a case of extralobar pulmonary sequestration in which magnetic resonance (MR) angiography was performed. Two-dimensional time-of-flight (TOF) MR angiography with three-dimensional (3D) rendering techniques allowed very accurate anatomical depiction of venous structures. 3D TOF MR angiography was also performed but provided disappointing results. The MR angiographic techniques are described and compared with contrast-enhanced CT and MR imaging. Correspondence to: J. Verschakelen     

动脉性肺隔离症的多层螺旋CT诊断

目的 评价动脉性肺隔离症(AS)的MSCT影像特征.方法 回顾性分析5例AS患者的MSCT影像资料,5例均行MSCT增强扫描,并进行3D图像重组,分析异常体循环动脉(ASA)、肺动静脉、支气管和肺实质的影像特征.结果 5例均可见单支粗大的ASA从降主动脉发出,迂曲扩张,先向下随即朝上朝前外,供血左下叶基底段,ASA供血区正好与肺动脉供血缺如区一致,肺静脉明显增粗.4例为典型AS,有典型的ASA,与左下肺静脉(IPV)紧贴,2支跨过IPV前方下行,至前内基底段,2支在IPV后方下行,至外后基底段;受累肺体积缩小,血管断面增多、增粗.在肺动脉供血与ASA供血移行区有一个特征性的乏血管带,其内支气管缺乏血管伴行.1例为不典型AS,受累肺合并先天性支气管闭锁.结论 AS有特征性的MSCT表现,典型表现可以直接诊断,不典型表现需要结合3D后处理图像仔细分析.     

Computer tomography versus aortography in diagnosis of aortic dissection

The use of computed tomography (CT) versus aortography is evaluated in a limited study of 17 cases of aortic dissection (AD). With the constraints of the present state of the technology and lack of availability of CT scanners at some centers, aortography remains the premier and often the only diagnostic test to choose in an emergency. CT, however, may be an asset in the diagnosis of AD when: (1) atypical or misleading clinical presentations are evident that do not require aortography; (2) aortography is contraindicated in a weakened patient, when there is no emergency; (3) aortography is a risk while there is a strong suggestion of AD; (4) patency of a false channel must be confirmed. These circumstances were encountered in five patients. In addition, a localized infrarenal AD was fortuitously discovered in two patients presenting with abdominal visceral cancer. On patient follow-up, CT is less invasive and may be performed in asymptomatic patients undergoing treatment, thereby facilitating the early detection of complications. Detailed computed tomograms often yield superior diagnostic information only if the CT study includes rapid sequential scans immediately following a fast intravenous bolus of contrast material.     

Transbrachial arteriography: Techiques and complications

A study of 72 patients angiographically examined by the percutaneous transbrachial technique with 4–5F catheters is reported. Even though the patients were preselected to reduce the risk of the technique, an unacceptably high incidence (7%) of major complications, including 3 patients requiring surgery for brachial thrombosis, was encountered. Although transbrachial catheterization with single 4F catheter midstream injections as reported in the literature may be safe, this technique is unwarranted when selective studies are planned and the alternative transfemoral approach is available.     

Double aortic arch associated with pulmonary sequestration

Double aortic arch and pulmonary sequestration, both uncommon vascular malformations, were seen in a six-month-old infant. The diagnosis was made by angiography, and successful surgical correction of both lesions was performed.     

产前超声及磁共振成像在胎儿肺隔离症诊断中的价值探讨

目的 探讨超声及MRI诊断胎儿肺隔离症的临床应用价值.方法 对12例产前超声怀疑胎儿肺隔离症者,24h内进行MRI检查,诊断结果均经尸检病理及产后随访证实.对12例胎儿的超声和MRI图像资料进行分析,并与随访结果对照.结果 产前超声诊断的12例胎儿肺隔离症,超声诊断符合率83.3％,误诊2例,（1例为隔疝,1例为肺囊腺瘤）;产前MRI检查诊断准确率为91.7％,误诊1例（隔离肺误诊为腹腔肿瘤）.结论 产前超声检查是诊断胎儿肺隔离症主要筛选方法,MRI可以作为胎儿超声检查的重要补充,二者联合应用,可进一步提高该病的诊断率.     

Selective digital subtraction arteriography in necrosis of the femoral head

Summary Selective digital subtraction arteriographic investigations of the arteries of the femoral head in 31 patients with traumatic and 34 patients with nontraumatic femoral head necrosis (FHN) were compared with investigations in a control group of 35 patients without hip disease. In the control group and in patients with nontraumatic FHN atypical arteriographic findings were found only in one third of cases. In traumatic FHN, however, vascular alterations could be detected in 97% of cases. This evidence suggests that damage to the femoral head vessels is a major etiological factor in traumatic, but not in nontraumatic, FHN. In late arterial phases of DSA a perinecrotic hypervascularization was the common feature in all nontraumatic necroses and could be observed in 71% of traumatic necroses. Its pathophysiological mechanism is discussed.     

MSCTA对肺周围病变侵犯段以下肺动脉的诊断价值

目的：探讨MSCTA对肺周围病变侵犯段以下肺动脉的诊断价值。方法：对362例肺周围病变行16层螺旋CT肺动脉造影,对其中段以下肺动脉受侵犯且经病理证实的35例进行分析。结果：段以下肺动脉可疑侵犯5例（良性2例,恶性3例）;轻度侵犯18例（良性1例,恶性17例）;重度侵犯12例（良性0例,恶性12例）。肺动脉轻重度侵犯对恶性病变的诊断准确率达96.7%,但肺动脉侵犯程度与良恶性结果间无显著性差异（P〉0.05）。结论：16层螺旋CT肺动脉造影能很好地显示周围病变侵犯段或亚段肺动脉的部位和程度,对诊断恶性病变具有重要参考价值。     

多层螺旋CT在儿童肺隔离症诊断中的应用

目的 探讨多层螺旋CT在肺隔离症诊断中的应用价值.方法 回顾性分析18例经手术病理证实为肺隔离症患儿的多层螺旋CT表现.所有患儿均行CT平扫及增强检查,并行图像后处理.评价各重组方法对肺隔离症及其相关畸形的诊断价值.结果 增强扫描横断面发现异常供血动脉12例,不能确定6例.经多种重组方法处理图像可直观显示全部异常供血动脉,并发现回流静脉13例;肺发育异常及其他系统畸形14例.容积再现(VR)对肺隔离症的异常供血血管及气道显示最佳.结论 多层螺旋CT增强扫描结合图像后处理可清晰显示肺隔离症及异常动静脉及伴发畸形,为儿童肺隔离症的首选检查方法.     

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。     

Complications of coronary arteriography: A follow-up report

A nationwide survey of complications due to coronary arteriography during 1973–74 yielded responses from 176 hospitals (89,079 coronary arteriograms). The overall mortality rate three times as high for non-heparinized as for heparinized patients. In institutions performing fewer than 100 examinations per year, the combined incidence of death, myocardial infarction, and cerebral embolism was five times higher than in institutions performing more than 400 examinations per year. Left main coronary artery or three-vessel disease was present in most patients who died of the procedure. Compared to a previous survey of 1970–71, there was a profound decrease in significant complications (including death, myocardial infarction, and cerebral embolism) and entry site complications such as thrombosis. A reduction in mortality with the femoral technique since 1971 was not accounted for by heparinization and may reflect increasing experience with the method and shorter angiographic times. Supported in part by USPHS grants HL20895, HL05832, and GM18674     

Non-traumatic thoracic emergencies: CT diagnosis of acute pulmonary embolism: the first 10 years

Over the past 10 years, spiral CT angiography of the pulmonary arteries has reached a high accuracy in the evaluation of pulmonary embolism. Major advantages of CT compared with ventilation/perfusion lung scintigraphy and pulmonary angiography is direct visualization of clots in the pulmonary arteries, and to provide alternative findings or diagnosis. The recent introduction of multislice CT has improved the evaluation of peripheral pulmonary arteries, enabling high-resolution CT examinations over the entire thorax in a short breathhold. The examination techniques, imaging findings, pitfalls, and results of CT in the diagnosis of pulmonary embolism are reviewed in comparison with other diagnostic tests.     

MR angiography of congenital heart disease: Value of segmented two-dimensional inflow technique and maximum-intensity-projection display

Magnetic resonance (MR) angiography of the cardiovascular system was evaluated in 41 patients with congenital heart disease by using a two-dimensional (2D) inflow technique based on a magnetization-prepared gradient-echo pulse sequence with segmented k-space data acquisition and electrocardiographic gating at 0.5 T. Inversion and saturation prepulses were used to suppress stationary tissue and enhance intravascular signal. Presaturation slabs were applied where certain vascular structures had to be suppressed. Sequence parameters were optimized by evaluating signal intensity and contrast characteristics for various flip angles and inversion and saturation delay times. The heart and intrathoracic vasculature were encompassed with 40–50 overlapping sections. Both 2D angiograms and maximum-intensity-projection images were evaluated. Combining data sets acquired in the sagittal and transverse orientations provided the most satisfactory information about the pulmonary arteries. The highest signal-to-noise ratios were obtained with a flip angle of 65° and short prepulse delay times. Two-dimensional MR angiography can provide useful diagnostic information but requires a thorough understanding of in-plane and hemodynamically induced signal intensity changes.