支气管粘液嵌塞的CT诊断

支气管粘液嵌塞为不同疾病的继发改变或合并症,一般是由感染、外伤或手术等原因引起细支气管内的粘液排泄受限而引起。现在由于高龄卧床患者及外伤后人工气道建立的患者增多,本症在临床上并不少见,但对其认识较少。     

High attenuation mucous plugs in allergic bronchopulmonary aspergillosis: CT appearance.

Allergic bronchopulmonary aspergillosis is an immunologic disease characterized by bronchiectasis and recurrent mucous plugging in asthmatics. The usual CT appearance is that of low attenuation branching structures corresponding to impacted dilated bronchi. We report a patient with allergic bronchopulmonary aspergillosis and mucous plugging manifested by high attenuation structures on CT. A follow-up examination demonstrated resolution of the mucous secretions and residual bronchiectasis. Possible etiologies for this CT appearance are discussed.     

Sudden death due to pulmonary aspergillosis

Sudden death due to respiratory pathology is not uncommon and tuberculosis with its complications is well known to cause death. We report a case of a male, train passenger, who started coughing out blood and died on reaching the hospital. Medicolegal autopsy confirmed the sudden unexpected death to be due to pulmonary aspergillosis in the person with past medical history of tuberculosis.     

Novel approach to complex pulmonary arteriovenous malformation embolization using detachable coils and Amplatzer vascular plugs

Introduction

We evaluated the feasibility of a modified embolization technique of pulmonary arteriovenous malformations (PAVM) using venous sac embolization with detachable coils combined with the feeding artery embolization with the Amplatzer vascular plug (AVP).

Materials and methods

We retrospectively studied technical and clinical success in the treatment of 11 complexe PAVMs. We recorded number and size of feeding arteries and draining vein, the last prior and post treatment in the follow up CT, size of PAVMs; and the number of devices needed to occlude each PAVM.

Results

11 complexe PAVM were treated with detachable coils to venous sac embolization followed by AVP to embolize feeding arteries. In all but one case a complete occlusion of the PAVM was angiographically achieved. The mean number of feeding vessel was 2.64 ± 0.92 (2–5). The mean number of coils was 7.82 ± 5.09 (3–20 coils). CT-follow-up, that was possible in 8 patients, showed a significant reduction of the draining vein size. The mean diameter reduction of the draining vein was 62 ± 18% varying between 29% and 77%. In all but one case with the complexe angioarchitecture the reduction of draining vein size close to 70% was achieved.

Conclusions

Our study implies that the venous sac embolization using the detachable coils followed by occlusion of the large feeding arteries using the AVP is a highly efficient method for the treatment of the complex PAVMs with large out-flow vessels and short feeding arteries.     

Scorpion-sting induced unilateral pulmonary edema

Unilateral presentation of pulmonary edema, though well documented in the medical literature, is an uncommon entity. Pulmonary edema due to scorpion sting is common but its unilateral presentation is rare. We report a case of unilateral pulmonary edema following a one-hour onset of scorpion envenoming. The patient was symptomatically treated at the intensive care unit and discharged the following day in a good condition to the medical ward. Medical and interventional causes of unilateral pulmonary edema are discussed in this paper along with the pathophysiology of bilateral and unilateral pulmonary edema caused by scorpion envenomation.     

Reperfusion of pulmonary arteriovenous malformations after successful embolotherapy with vascular plugs

Amplatzer vascular plugs (AVPs) are among the embolic agents currently used for occlusion of pulmonary arteriovenous malformations (PAVMs). The authors encountered a patient with multiple PAVMs who developed spontaneous reperfusion of two PAVMs within 7 weeks of initially successful embolization with AVPs. Reperfused PAVMs were effectively occluded by coils deposited proximal to the vascular plugs. AVPs do not provide consistent long-term occlusion of the PAVMs. Deposition of coils proximal to the AVP may decrease the chance of PAVM reperfusion after the embolization.     

Cervical pulmonary herniation due to blunt chest trauma

Traumatic lung herniation through the superior thoracic aperture rarely occurs. In this case report we present a motor vehicle accident of a 40 year old male victim with cervical lung herniation. After an enormous blunt trauma to the chest, the disrupted and lacerated lung tissue left the thoracic cavity and was pushed into the laryngeal and oral cavity. Extrathoracic post-traumatic lung herniation through the thoracic inlet and connective tissue spaces of the neck into the oral cavity is a unique complication of blunt trauma to the chest, and the post-mortem medico-legal investigations may collect more information about this phenomenon.     

Acute pulmonary schistosomiasis

Acute pulmonary schistosomiasis occurs in non-immune hosts, particularly visitors to regions where Schistosoma species are endemic. While radiological findings of acute pulmonary schistosomiasis might resemble neoplastic or granulomatous disease, an appropriate travel history might suggest the diagnosis. With rising popularity of travel to Africa and South-East Asia, the incidence of acute pulmonary schistosomiasis can be expected to increase. We describe a case of acute pulmonary schistosomiasis occurring in an Australian returning from Lake Malawi, Sub-Saharan Africa.