Localized pulmonary edema in the right upper lobe associated with left atrial myxoma

Localized pulmonary edema in the right upper lobe has usually been reported in patients with mitral incompetence. Cardiac myxomas that involve the left atrium can cause elevated filling pressure with resultant bilateral or symmetric pulmonary edema. To our knowledge, however, a case of localized pulmonary edema associated with cardiac myxoma has not previously been reported in the literature. We present a case of localized pulmonary edema in the right upper lobe associated with left atrial myxoma.     

Cardiomegaly as a cause of nonuniform pulmonary artery perfusion.

In patients with cardiomegaly, a common cause of nonuniform pulmonary artery perfusion on pulmonary arteriograms is compression of the left lower lobe arteries by the enlarged heart, an effect which is accentuated by gravity in the supine position. This may impede flow in such a manner as to erroneously suggest the presence of pulmonary emboli. Subselective left lower lobe arteriography with the patient in the right posterior oblique position will allow better anatomic definition of the vessels in this region and result in fewer equivocal or false positive studies.     

SPECT/CT肺灌注显像中肺段精确定位方法的研究

目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段:上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段;左肺8段:上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点:(1)横断面双肺由肺尖至肺底选取11个层面:胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面;(2)双肺由内向外分别选取6个层面,左肺:左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面;右肺:右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外;(3)冠状面双肺由前向后选取7个层面:胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据.     

SPECT/CT肺灌注显像中肺段精确定位方法的研究

目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段:上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段;左肺8段:上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点:(1)横断面双肺由肺尖至肺底选取11个层面:胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面;(2)双肺由内向外分别选取6个层面,左肺:左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面;右肺:右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外;(3)冠状面双肺由前向后选取7个层面:胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据.     

SPECT/CT肺灌注显像中肺段精确定位方法的研究

目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段：上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段 左肺8段：上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点：（1）横断面双肺由肺尖至肺底选取11个层面：胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面 （2）双肺由内向外分别选取6个层面,左肺：左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面 右肺：右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外 （3）冠状面双肺由前向后选取7个层面：胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据.     

Tc-99m MAA findings in dilated cardiomyopathy with partial anomalous venous connections

Tc-99m MAA showed asymmetric uptake in the lung field in a 21-year-old man with dilated cardiomyopathy. CT revealed partial anomalous venous connections in the left upper lobe. Angiogram of the left pulmonary upper lobe showed all the contrast material drained into the left vertical vein. The possible cause of relative increase in the left upper lobe blood flow is that right pulmonary blood flow is slowed by the high pressure in the left atrium due to dilated cardiomyopathy, whereas the flow from the left upper lobe drains into the superior vena cava which has less pressure than left atrium.     

R?ntgen appearances of pulmonary edema and their clinical and physiologic correlates (author's transl)]

With the rapid increase in the number of intensive care units in surgical and medical departments knowledge of early radiologic signs of pulmonary edema gains in importance. On the basis of investigations by American authors typical changes in the distribution of pulmonary blood supply can be shown, in good correlation with pressure changes in the pulmonary vein in left heart failure. When pressure rises in the pulmonary vein the well-know changes of interstitial or alveolar (acinary) pulmonary edema arise. Differential diagnosis between pulmonary edema due to left heart failure and edema from other causes is aided on the one hand by the presence of interstitial pulmonary edema and redistribution of blood, on the other hand by the abnormaly large heart and configuration. Neither R?ntgen appearances nor type of distribution of pulmonary edema are specific for any given cause. In all cases of pulmonary edema, the primary-peripheral excepted, clinical signs either occur later than X ray findings or will be absent altogether. Respiratory physiology permits, according to the severity of the edema, proof of hypoxemia with pronounced differences in the regional ventilation-perfusion quotient up to marked reduction of compliance and increase of resistance.     

Radiographic diagnosis of cardiogenic pulmonary edema]

Development of pulmonary edema (increased extravascular lung water) is a common and sometimes life-threatening clinical problem in critical-care unit patients. There are three principal causes: cardiac failure, overhydration, and increased pulmonary capillary permeability. Among these, cardiogenic edema consists of left heart failure and overhydration. Determining the specific cause of any given case of pulmonary edema is important and leads to more rapid and definitive treatment. A plain chest film can often explicate the cause of edema with a high degree of accuracy if careful attention is given to certain radiographic features. The principal features useful for correctly determining the cause of edema in a high percentage of cases are the distribution of pulmonary blood flow, distribution of pulmonary edema, and vascular pedicle width. Ancillary features are pulmonary blood volume, bronchial cuffing, septal lines, pleural effusion, and air bronchograms. Cardiac size and shape as well as specific intracardiac calcifications could also help distinguish cardiogenic from noncardiogenic pulmonary edema.     

Pulmonary edema localized in the right upper lobe accompanying mitral regurgitation

Focal patterns of pulmonary edema are confusing and often mistaken for the more common causes of focal lung disease, pneumonia, infarction, or aspiration. The authors report four cases of right upper lobe edema secondary to mitral regurgitation. The pathogenesis believed to be responsible for this condition is the vector of blood flow from the left ventricle to left atrium, which may be targeted at the right superior pulmonary vein, locally accentuating the forces for edema formation in the right upper lobe. Pulmonary edema accompanying mitral regurgitation should be suspected whenever right upper lobe consolidation develops in a patient with known or suspected mitral valve disease. The presence of interstitial edema in the remainder of the lungs can help in the differentiation of this condition from pneumonia and other disorders.     

Measurement of the blood flow velocity in the pulmonary arteries using the magnetic resonance technique]

MR blood velocity measurements were performed by the RACE technique in a plane perpendicular to the flow of the pulmonary arteries. MR findings were correlated with those of perfusion scintigraphy, Doppler US and right heart catheter (thermodilution). The ratio of MR blood flow measurements of right and left pulmonary arteries correlated well with the results of perfusion scintigraphy (RPA to LPA) and Doppler. Poor correlation was found when comparing MR blood flow measurements with right heart catheter since absolute flow measurements can be superimposed by neighboring blood vessels in complex anatomic situations.     

Bioimpedance measurement with respect to pulsatile pulmonary blood flow

We used four-electrode electrical impedance plethysmography (IPG) to estimate regional pulmonary perfusion at three lung volumes, RV, FRC, and TLC. To define the region, the upright lung was divided into four equal sampling areas dorsally along the paravertebral space. The Kubicek formula was used to calculate pulmonary perfusion. Regional base resistance (Ro) decreased from the top to about 3/4 down the lung and then leveled off. The regional perfusion (Qz) showed an increase from the apex to about 3/4 down the lung and thereafter decreased toward the base, except at TLC. The regional distribution of the electrical derivative of resistance (dR/dt) resembled that of Qz because there was no statistically significant difference in ventricular ejection time or heart rate among studies. The value of the arithmetic sum of regional Ro was significantly larger than that of Ro for the total sampling field while the reverse was true for Qz. These discrepancies can be explained on the basis of the lead field theory applied to IPG. The regional perfusion gradient determined by IPG represents the pulsatile perfusion gradient in vivo because the outputs from the impedance analyzer are intimately linked to the pulse-synchronous pulsatile nature of pulmonary blood flow. Safe, simple, and noninvasive IPG can be used to study regional pulmonary perfusion in clinical situations, high altitude, or unusual environments.     

头低位-30°卧床肺循环血液动力学的改变

目的观察模拟失重条件下心肺循环变化的特点。方法采用超声多谱勒技术对１２ 名健康男性青年,在头低位－ ３０°４５ ｍｉｎ 时,测量了心功能的变化。结果 实验中右心室射血时间显著增加（ Ｐ＜ ０ ．０５） ,肺动脉最大血流速度显著下降（ Ｐ＜ ０ ．０５） ,肺动脉血流加速时间延长,右心室心输出量在１０ ｍｉｎ 、３０ ｍｉｎ 显著下降（ Ｐ＜ ０ ．０５） ,心率、右心室心搏量、肺动脉平均血流速度、肺动脉血流加速度均有下降的趋势,但不具有显著性。左心室输出量、左心室心搏量及血压的变化趋势与国内外报道的相似。结论从右心功能的各个参数的变化,提示在头低位的实验过程中肺循环阻力增高,阻力的增加是肺动脉压增高的直接原因。     

Quantitative evaluation of MR perfusion imaging using blood pool contrast agent in subjects without pulmonary diseases and in patients with pulmonary embolism

Objective

To assess the feasibility of time-resolved parallel three-dimensional magnetic resonance imaging (MRI) for quantitative analysis of pulmonary perfusion using a blood pool contrast agent.

Methods

Quantitative perfusion analysis was performed using novel software to assess pulmonary blood flow (PBF), pulmonary blood volume (PBV) and mean transit time (MTT) in a quantitative manner.

Results

The evaluation of lung perfusion in the normal subjects showed an increase of PBF, PBV ventrally to dorsally (gravitational direction), and the highest values at the upper lobe, with a decrease to the middle and lower lobe (isogravitational direction). MTT showed no relevant changes in either the gravitational or isogravitational directions. In comparison with normally perfused lung areas (in diseased patients), the pulmonary embolism (PE) regions showed a significantly lower mean PBF (20?±?0.6?ml/100?ml/min, normal region 94?±?1?ml/100?ml/min; P?P?P?Conclusion Our results demonstrate the feasibility of using time-resolved dynamic contrast-enhanced MRI to determine normal range and regional variation of pulmonary perfusion and perfusion deficits in patients with PE.

Key Points

? Recently introduced blood pool contrast agents improve MR evaluation of lung perfusion ? Regional differences in lung perfusion indicating a gravitational and isogravitational dependency. ? Focal areas of significantly decreased perfusion are detectable in pulmonary embolism.     

基于肺部血流MRI信号在心动周期内变化的灌注成像技术研究

目的探讨血流变化对肺部MRI信号的影响，并研究1种新的MR肺血流灌注成像方法。方法对健康志愿者15例，采用相位对比电影MRI技术测量大肺动脉血流速度和流量在心动周期内的变化；并选用单次激发半傅立叶变换超快速自旋回波序列观察肺实质MR信号的相应改变，评价其相关性；根据不同心动期相肺实质MR信号的差异进行图像减影。结果肺实质．MRI信号表现为心脏收缩期降低，舒张期升高。大肺动脉的瞬时速度、瞬时流量与其呈负相关(r=-0．878、-0．770，P=0，002、0．015)。经肺部MRI信号差异最大的舒张末期和收缩中期的MRI减影可获得肺灌注像。结论肺实质MRI信号的改变与肺血流模式和速度有关。该技术是1种简便易行的非对比剂性的MR肺灌注评价新方法。     

Regional pulmonary perfusion in patients with acute pulmonary edema.

Redistribution of pulmonary blood flow (PBF) away from edematous regions of the lung is characteristic of experimental acute lung injury (ALI), helping to preserve ventilation-perfusion matching and gas exchange. The purpose of this study was to determine if such perfusion redistribution occurs in acute pulmonary edema in humans. METHODS: We measured the regional distribution of lung water concentration (LWC) and PBF with PET in 9 patients with ALI, 7 patients with non-ALI pulmonary edema, and 7 healthy subjects. RESULTS: The average patient chest radiographic score was 7.5 +/- 2.2 (scale: 0-12, where > or =4 met our criterion for pulmonary edema). The mean partial pressure of oxygen, arterial/fraction of inspired oxygen ratio (PaO(2)/FIO(2)) was 192 +/- 78. LWC was 35 +/- 4 mL H(2)O/100 mL lung versus 20 +/- 5 mL H(2)O/100 mL lung in the healthy subjects (P < 0.05). On average, the ventral-to-dorsal regional distribution of PBF was similar in patients with pulmonary edema and healthy subjects, regardless of the etiology of the pulmonary edema. However, LWC and an index of perfusion redistribution away from edematous lung regions, when combined, were a significant determinant of the PaO(2)/FIO(2) (coefficient of determination [R2] = 0.53; P = 0.03). CONCLUSION: These results suggest that hypoxic vasoconstriction is severely blunted in ALI. The perfusion redistribution that does exist contributes slightly to improved oxygenation during early pulmonary edema in humans.     

Detection of superior vena cava stenosis with superior vena cava-superior left pulmonary artery shunt and pulmonary hypertension. Detection by nuclear medicine study

We present a 59 year old patient diagnosed of right superior lobe pulmonary carcinoma by CT scan. A ventilation/perfusion pulmonary scintigraphy quantified for study of pulmonary function after surgery was performed. The images show an abnormal pattern of the distribution of macroaggregate albumin (MAA) and extrapulmonary presence of tracer (right/left shunt). A first step dynamic study showed the existence of superior cava stenosis and passage of the tracer from the vena cava to the left pulmonary artery by collateral circulation (innominate vein) that not only explained the existence of the abnormal pattern of the MAA distribution but also what the cause of the right/left shunt was. After the resolution of the stenosis, the distribution pattern became normal and the extrapulmonary presence of MAA disappeared.     

Computerized tomography in pulmonary infarction]

We performed a retrospective study of CT findings in 14 patients with 61 lesions of pulmonary infarction diagnosed clinically and radiographically. All cases except one had multiple pleural-based parenchymal lesions, and in five cases the lesions were bilateral. The site of pulmonary infarction was the right lower lobe in 24 lesions, left lower lobe in 19 lesions, right upper lobe and left upper lobe in seven lesions each, and right middle lobe in four lesions. Fifty-nine infarctions (excluding two segmental lesions) were divided into two groups according to the size of the lesions: a group of lesions 2 cm or more in size and a group less than 2 cm. Nineteen lesions in eight patients were in the larger group and 40 lesions in 12 patients in the smaller group. The typical CT findings of larger infarctions were pleural based parenchymal density with truncated apex, centrally directed linear shadow and inside low attenuation area indicating viable lung. Pleural thickening and effusion were frequently seen. No air bronchograms were seen in these subsegmental lesions. Smaller lesions were believed to indicate infarction of a single secondary pulmonary lobule, considering their size and shape. CT scan was able to detect these small lesions (single lobular infarctions) more frequently than chest radiography. One segmental lesion with air bronchogram was thought to represent atelectasis and the other one to represent pulmonary hemorrhage and edema. CT examination is useful for the detection and diagnosis of pulmonary infarction.     

Endovascular Treatment of a Coronary Artery Bypass Graft to Pulmonary Artery Fistula with Coil Embolization

Fistula formation between a coronary artery bypass graft (CABG)and the pulmonary arterial circulation represents a rare cause of recurrent angina in patients following bypass grafting. Therapy has traditionally involved surgical ligation by open thoracotomy. We describe a case of left internal mammary artery–left upper lobe pulmonary artery fistula presenting as early recurrent angina following CABG. The fistula was embolized using platinum coils, resulting in symptomatic relief and improvement in myocardial perfusion on cardiac perfusion scintigraphy. Coil embolization should be considered a therapeutic option in patients with coronary–pulmonary steal syndrome.     

Unusual pattern of lung uptake of technetium-99m sulfur colloid seen on the liver scan of a patient with pulmonary tuberculosis

In evaluating alcoholic liver disease in a patient with pulmonary tuberculosis, a liver-spleen scan was performed that showed an unusual uptake of sulfur colloid in the lungs. There was diffuse uptake in the left lung and portions of the right lower lung with absent uptake in the right upper lobe and portions of the right lower lung corresponding to areas of pulmonary consolidation. A perfusion lung scan confirmed absent pulmonary arterial perfusion in these areas and a gallium scan demonstrated active infection there.     

Varicose veins of the lung

Varicosity of the pulmonary veins is a rare anomaly of the pulmonary vascular system. The varices do not usually change in size over years, do not cause symptoms and need no therapy. However, raised left atrial pressure can cause increase in the diameter of pulmonary vein varices. A case of lung vein varicosity in the right middle and upper lobe associated with coarctation of the aorta and an anomalous upper-middle lobe vein was observed over a period of 10 years. Increase in left atrial pressure (aortic and relative mitral regurgitation) led to enlargement of the pulmonary veins.