Pulmonary artery dissection: MR findings.

We report a case of pulmonary artery dissection imaged by MR. Dissection of a markedly dilated pulmonary artery is a rare and usually fatal complication of chronic pulmonary arterial hypertension. The diagnosis is made at autopsy, with only two cases having previously been documented (by Doppler echocardiography) during life. The hallmark of an arterial dissection is the finding of an intimal flap and a false lumen. In our case, spin echo MR imaging failed to show either the intimal flap or any intraluminal signal defects. The dissection was presumably obscured by nonhomogeneous intraluminal signal caused by the slow blood flow associated with severe pulmonary arterial hypertension. Cine MR imaging, however, demonstrated different signal intensity within the true and false lumens of the dissection, thereby outlining the intimal flap between the two channels.     

Pulmonary artery dissection in long standing idiopathic pulmonary arterial hypertension: A case report

Pulmonary arterial dissection (PAD) is a rare and often lethal complication of chronic pulmonary arterial hypertension (PAH), which may occurs in patients with idiopathic pulmonary arterial hypertension (IPAH) and potentially in those with connective tissue disorders. While rare, sudden death often occurs secondary to acute cardiac tamponade, as the pulmonary artery dissects into the pericardium; this diagnosis is often made postmortem. Nevertheless, with the proliferation of multidetector computed tomography (MDCT) as a diagnostic test, patients may be identified very early after symptom onset, prompting rapid intervention with decreased morbidity and mortality. We report a case of IPAH complicated by pulmonary artery aneurysm (PAA) and PAD, diagnosed by CT pulmonary angiogram (CTPA), and treated with bilateral lung transplantation, pulmonic valve replacement, and re-anastomosis of the donor main PA to a pulmonary valve conduit.     

CT findings of pulmonary artery dissection

Pulmonary artery dissection is a serious fatal complication of chronic pulmonary arterial hypertension, always occurring at the site of maximal dilatation of the artery. Diagnosis is made mainly at autopsy as many of these patients experience sudden death when the main pulmonary artery dissects into the pericardium, causing acute cardiac tamponade. To our knowledge, five reported cases have described CT imaging findings of acute pulmonary artery dissection in the literature.     

Transcatheter Embolization of Pulmonary Artery False Aneurysm Associated with Primary Pulmonary Hypertension

A 29-year-old woman with primary pulmonary hypertension presented with recurrent hemoptysis. Contrast-enhanced CT of the chest demonstrated the enhanced mass surrounded by consolidation related to parenchymal hemorrhage. Pulmonary angiography suggested that the mass was a pulmonary artery false aneurysm. After a microcatheter was superselectively inserted into the parent artery of the false aneurysm, the false aneurysm was successfully treated by transcatheter embolization with coils. Her hemoptysis has never recurred.     

Mycotic Pulmonary Artery Aneurysm as an Unusual Complication of Thoracic Actinomycosis

Although pulmonary artery aneurysms are a rare vascular anomaly, they are seen in a wide variety of conditions, such as congenital heart disease, infection, trauma, pulmonary hypertension, cystic medial necrosis and generalized vasculitis. To our knowledge, mycotic aneurysms caused by pulmonary actinomycosis have not been reported in the radiologic literature. Herein, a case of pulmonary actinomycosis complicated by mycotic aneurysm is presented. On CT scans, this case showed focal aneurysmal dilatation of a peripheral pulmonary artery within necrotizing pneumonia of the right lower lobe, which was successfully treated with transcatheter embolization using wire coils.     

Pulmonary artery rupture during Swan-Ganz catheterisation: A case report

Catheter-induced pulmonary artery rupture is an infrequent complication that may occur during invasive cardiopulmonary monitoring. Fatal cases are uncommon and result from hemoptysis and flooding of the opposite lung with resulting hypoyxia. Alpha-1-antitrypsin deficiency is a rare genetic disorder characterised by low serum levels of alpha-1-antitrypsin, critical in maintaining connective tissue integrity. Besides pulmonary emphysema, recent observations suggest that alpha-1-antitrypsin deficiency may also be involved in vascular wall weakening, thereby predisposing arteries to dissection and aneurysm formation. In this article, we describe an autopsy case of pulmonary artery iatrogenic rupture due to insertion of a Swan-Ganz catheter in an 82-year-old woman suffering from pulmonary hypertension and alpha-1-antitrypsin deficiency. The exact source of bleeding could not be precisely identified during autopsy due to the extent of tissue hemorrhage, though postmortem angiography revealed a contrast medium extravasation from a branch of the left pulmonary lower lobar artery. The case herein emphasises the importance of postmortem angiography in facilitating the detection of vascular injuries, the importance of familiarity with intensive care techniques and procedures on behalf of forensic pathologists as well as in-depth knowledge of all possible contributing conditions and predisposing disorders in the pathogenesis of death.     

Renal Artery Stent Placement Complicated by Development of a Type B Aortic Dissection

Percutaneous renal artery angioplasty and stent placement have demonstrated safety and effectiveness in the treatment of selected patients with renovascular hypertension and ischemic nephropathy. Major complications have been predominantly confined to the affected renal artery and kidneys, including renal artery dissection and/or thrombosis, distal embolization, and contrast-related nephropathy. We report a case in which treatment of an ostial renal artery lesion with placement of a balloon-expandable stent was complicated by the development of an acute Type B aortic dissection.     

Pulmonary artery intimal injury associated with blunt trauma

In recent years, intimal injuries to the aorta (minimal aortic injuries) have been diagnosed more frequently. We report the first case of pulmonary artery intimal injury in the setting of blunt trauma. We propose a number of theories regarding the pathogenesis, outcome, and treatment of pulmonary artery intimal injuries, drawing inferences from aortic intimal injuries. We conclude with a discussion on differentiating pulmonary artery intimal injury from the more common (but still rare) pulmonary artery dissection, using our case as an example.     

Concurrent dissections of ascending aorta and right coronary artery during primary coronary angioplasty

We present a case of dissection in ascending aorta (AA) accompanying dissection of the right coronary artery (RCA) during transfemoral primary coronary angioplasty (PCA) for acute inferior myocardial infarction (MI). To our best knowledge, this is the first case of dissection both in AA and RCA during angioplasty for acute MI. The dissection in RCA was caused by balloon inflation during PCA. Most probably, an angiographically invisible retro-dissection in RCA resulted in the dissection in AA. A computed tomography (CT) confirmed the diagnosis of aortic dissection that was restrained in AA. The patient was treated conservatively. Five days after the event, a control CT demonstrated that the false lumen in AA disappeared and the dissection was healed entirely.     

Pulmonary hypertension: Work in progress

Pulmonary arterial hypertension is a rare disorder defined by mean pulmonary artery pressures that exceed 25 mm Hg at rest or are greater than 30 mm Hg with exercise. The mortality rate is high for untreated patients, mainly as a result of progressive right heart dysfunction. Pulmonary arterial hypertension has been historically classified as primary pulmonary hypertension or pulmonary hypertension resulting from an underlying disease process. Ongoing research in the nuclear medicine field holds great promise for understanding the pathophysiologic pathways for this condition, as well as the monitoring of the continually evolving therapeutic options.     

移居高原地区后肺动脉高压的葛根素治疗

目的：了解移居高原地区后出现肺动脉高压的葛根素注射液治疗效果。方法：选择移居高原地区5年以上、无高血压病、出凝血障碍及各器官器质性疾病，排除其它原因引起的肺动脉高压、诊断为高原低氧性肺动脉高压患者238例，随机分为葛根素注射液治疗组133例，复方丹参注射液对照组105例，分别于治疗前、治疗后观察肺动脉平均压、肺血管阻力、心输出量的变化及不良反应。结果：两组均降低肺动脉平均压、肺血管阻力，但以葛根素注射液治疗组的效果更明显（P〈0．01），葛根素注射液不减少心输出量，复方丹参注射液减少心输出量（P〈0．05）；葛根素注射液降低肺动脉平均压总有效率达96．99％，明显优于复方丹参注射液的82．86％（P〈0．01）。结论：葛根素注射液能降低高原低氧性肺动高压患者的肺动脉平均压及肺血管阻力，对心输出量无明显影响。是治疗移居高原地区后出现低氧性肺动脉高压的有效药物。     

Pulmonary hypertension and cor pulmonale

Summary Pulmonary hypertension is a severe disorder of the pulmonary circulation and occurs in a variety of vascular and parenchymal lung diseases. It leads to volume and/or pressure overload of the right ventricle and finally to right heart failure. Pulmonary vascular diseases such as chronic pulmonary embolism cause a drastic increase in pulmonary vascular resistance, which results in extremely high pulmonary artery pressures that can even reach systemic levels. On the other hand, moderate pulmonary hypertension can also occur in chronic obstructive and restrictive lung diseases. For a long time, the diagnosis of pulmonary hypertension and cor pulmonale was based upon findings in echocardiography and right heart catheterization. Today modern imaging techniques allow the radiologist to assess right ventricular and pulmonary artery morphology and function. The application of spiral CT, electron-beam CT and MRT permits the diagnosis and differential diagnosis of pulmonary hypertension and also the evaluation and follow-up of underlying vascular or parenchymal lung disorders. In addition, quantification of right ventricular function and calculation of pulmonary hemodynamic parameters are possible. Eingegangen am 28. Januar 1997 Angenommen am 5. Februar 1997     

Acute pulmonary trunk dissection in a patient with primary pulmonary hypertension

Spiral CT imaging findings including multiplanar reconstructions of an acute dissection of the pulmonary trunk in a 22-year-old female patient with primary pulmonary hypertension (PPH) are presented and discussed.     

Compression of the Right Pulmonary Artery by a Massive Descending Aortic Aneurysm Causing Bilateral Perfusion Defects on Pulmonary Scintigraphy

A 67-year-old woman, who presented with a 2 month history of dyspnea, had a ventilation and perfusion lung scan that showed absent perfusion of the entire right lung with normal ventilation, as well as a rounded matched defect in the left lower lung adjacent to midline, suspicious for an aortic aneurysm or dissection. CT pulmonary angiography revealed a massive descending aortic aneurysm compressing the right pulmonary artery as well as the left lung parenchyma, accounting for the bilateral perfusion scan defects. We present the Xe-133 ventilation, Tc-99m MAA perfusion and CT pulmonary angiography imaging findings of this rare case.     

64层螺旋CT心胸联合造影在急性胸痛病因鉴别诊断中的价值

目的 探讨64层螺旋CT在急性胸痛病因鉴别诊断中的临床价值。方法 对36例临床急性胸痛的患者行64层螺旋CT心胸联合血管造影检查。对所有扫描原始数据用冠状、矢状面多平面重组（MPR）、曲面重组（CPR）、容积再现（VR）和最大密度投影（MIP）等方法行冠状动脉、肺动脉和胸主动脉成像。由2名有经验的放射科医生对所有图像进行观察，对疾病进行诊断，其中16例患者同时行选择性血管造影检查。结果 所有行64层螺旋CT心胸联合血管造影的患者1次检查均可清晰显示双侧肺动脉、冠状动脉主干及其主要分支以及胸主动脉，同时均可进行纵隔及肺窗重组，对胸部疾病进行诊断。显示冠状动脉狭窄10例，急性肺动脉栓塞14例，主动脉夹层6例（其中1例同时伴有冠状动脉右支急性血栓形成）；并诊断气胸1例、缩窄性心包炎1例；4例未见明显异常。结论 64层螺旋CT1次心胸联合血管造影检查能清晰地显示冠状动脉、肺动脉及主动脉，对其病变作出正确诊断，还能清晰地显示胸部疾病，是急性胸痛病因诊断无创、可靠的检查方法。     

CTPA在急性肺动脉栓塞合并肺动脉高压诊断中的价值

目的探讨CTPA在急性肺动脉栓塞（acutepulmonaryembolism,APE）合并肺动脉高压（pulmonaryarterialhypertension,PAH）诊断中的临床应用价值。方法选择108例临床拟诊APE的患者进行超声心动图及cTPA检查,以肺动脉收缩压~30mmHg为PAH诊断标准,分成PAH组46例,其余肺动脉压〈30mmHg者62例作为对照组,分别在CTPA轴位图像上进行相关测量及影像学表现分析,并进行统计学处理。结果主肺动脉直径、主肺动脉与升主动脉直径比值、主肺动脉与降主动脉直径比值与肺动脉高压程度呈正相关,以主肺动脉直径≥2．9cm诊断PAH的敏感度、特异度均较高（分别为95．65％和88．71％）。主肺动脉与升主动脉直径比值〉1、主肺动脉与降主动脉直径比值〉1．1诊断PAH敏感度分别为53．33％和91．48％,特异度分别为92．41％和65．57％,三者联合诊断PAH的敏感度和特异度分别为56．85％、96．85％。结论CTPA能够对PAH做出较为准确的判断,对评价APE严重程度及预后提供重要依据。     

64排螺旋CT肺动脉与主动脉联合扫描技术

目的：探讨一次性完成肺动脉与主动脉 CT 造影检查技术。方法回顾性分析23例肺动脉与主动脉联合造影的患者CT 影像资料(A 组),另选肺动脉、主动脉 CT 造影正常的患者各13例为对照(B 组、C 组)。统计3组患者对比剂应用剂量和辐射剂量,观察异常血管显示情况,对比各组间正常肺动脉、主动脉 CT 值,以及4、5级肺动脉显示数量。结果A 组对比剂用量大于 B组和 C 组,但小于 B 组与 C 组之和;A 组辐射剂量与 C 组相当,明显少于 B 组与 C 组之和。23例中准确诊断6例肺动脉栓塞,1例肺动脉发育畸形;4例主动脉夹层,真假腔对比明显,5例主动脉炎,10例主动脉粥样硬化;结果正常者4、5级肺动脉显示数量、肺动脉与主动脉 CT 值和对照组对比均无统计学意义(P >0.05)。结论64排螺旋 CT 可一次性完成肺动脉与主动脉造影检查,对比剂用量和辐射剂量明显减少。     

Acute traumatic dissection of the common iliac arteries with spontaneous healing: Case report

Acute dissection of the abdominal aorta or common iliac arteries after blunt trauma is a very rare injury. We present an unusual case of acute traumatic dissection of the common iliac arteries. To our knowledge, this is the first reported case of acute traumatic dissection of the iliac arteries with ultimate spontaneous healing.     

Superior vena cava obstruction: Complication of pulmonary artery ectasia in levo-transposition of the great arteries

Obstruction of the superior vena cava developed in a 13-year-old child with levo-transposition of the great arteries and pulmonary artery hypertension. Obstruction was due to extrinsic compression of the superior vena cava by an ectatic main pulmonary artery.     

Tei指数评价高海拔地区肺动脉高压患者右心功能的临床研究

目的：探讨Tei指数评价高海拔地区肺动脉高压患者右心功能的临床价值。方法：对西宁地区48例肺动脉高压患者和33例正常人,行超声检查,测量右房横径、右室横径、右室前壁厚度、肺动脉主干内径根据三尖瓣返流和肺动脉瓣返流估测肺动脉收缩压、肺动脉舒张压、肺动脉平均压,并计算右心Tei指数。结果：肺动脉高压患者与对照组右心Tei指数有显著统计学差异,不同肺动脉压力组之间右心Tei也有统计学差异。结论：右心Tei指数是反映右心整体功能较敏感的指标。