Bronchial Artery Research Articles

488. LEFT BRONCHIAL ARTERY IN ESOPHAGEAL SURGERY

Abstract Commonest cause of morbidity after esophagectomy is pulmonary. Tracheobronchial devascularization during surgery contributes to this morbidity and can potentially lead to mortality. This video shows that left bronchial arteries can be preserved like the right ones in an attempt to aid rapid recovery of patients. This is the link to the video. https://drive.google.com/file/d/11iWQ5KUTSoc9qCmViCUlGPF61iCvCnJk/view?usp=share_link.

Epidemiology and Clinical Patterns of Lung Abscesses in ICU: A French Multicenter Retrospective Study

Data are scarce regarding epidemiology and management of critically ill patients with lung abscesses. What are the clinical and microbiological characteristics of critically ill patients with lung abscesses, how are they managed in the ICU, and what are the risk factors of in-ICU mortality? This was a retrospective observational multicenter study, based on International Classification of Diseases, 10th Revision, codes, between 2015 and 2022 in France. In-ICU mortality-associated factors were determined by multivariate logistic regression. We analyzed 171 ICU patients with pulmonary abscesses. Seventy-eight percent were male, with a mean age of 56.5 ± 16.4 years; 20.4%misused alcohol, 25.2%had a chronic lung disease (14%COPD), and 20.5%had a history of cancer. Overall, 40.9%were immunocompromised and 38%qualified for nosocomial infection. Presenting symptoms included fatigue or weight loss in 62%, fever (50.3%), and dyspnea (47.4%). Hemoptysis was reported in 21.7%. A polymicrobial infection was present in 35.6%. The most frequent pathogens were Enterobacteriaceae in 31%, Staphylococcus aureus in 22%, and Pseudomonas aeruginosa in 19.3%. Fungal infections were found in 10.5%. Several clusters of clinicoradiologic patterns were associated with specific microbiological documentation and could guide empiric antibiotic regimen. Percutaneous abscess drainage was performed in 11.7%; surgery was performed in 12.7%, and 12%required bronchial artery embolization for hemoptysis. In-ICU mortality was 21.5%, and age (OR: 1.05 [1.02-1.91], P= .007], renal replacement therapy during ICU stay (OR, 3.56 [1.24-10.57], P= .019), and fungal infection (OR, 9.12 [2.69-34.5], P= .0006) were independent predictors of mortality after multivariate logistic regression, and drainage or surgery were not. Pulmonary abscesses in the ICU are a rare but severe disease often resulting from a polymicrobial infection, with a high proportion of Enterobacteriaceae, S aureus, and P aeruginosa. Percutaneous drainage, surgery, or arterial embolization was required in more than one-third of cases. Further prospective studies focusing on first-line antimicrobial therapy and source control procedure are warranted to improve and standardize patient management.

Bronchial Artery Einbolization for Treatment of Hemoptysis from Cavitary Lung Lesions

Background Treatment for liemoptysis is not limited to surgery, and among the various options, bronchial artery emboli/anon is regarded as an effective approach. Aim of the Work To evaluate the technique, efficacy, and safety of Bronchial Artery Embolization in patients with haemoptysis from cavitary lung lesions. Patients and Methods Our study was a reconstructive (retrospective and prospective) cohort study that was held during the period between March 2021 and September 2021. The study included 20 patients who presented with hacmoptysis due to cavitary lung lesions refractory to supportive treatment measures. Patients were referred from chest department to interventional Radiology Unit, Ain Shams University Hospitals. Results Massive hemoptysis was seen in 15 patients and recurrent mild-moderate in 5 patients. On imaging cavitary lesions were seen at left side in 8 patients, right side in 8 patients, and bilateral involvement in 4 patients. Bronchiectatic changes were the predominant pathology seen in 6 patients, immediate success was achieved in 20 patients, while recurrence within one month was noted at 4 patients. Minor complications such as chest pain were recorded in 13 patients yet no major complications such as spinal cord ischemic. Conclusion BAE is a safe and effective procedure with a negligible complication rate that can be performed routinely in patients presenting with heimoptysis,

Even non-expert radiologists report chronic thromboembolic pulmonary hypertension (CTEPH) on CT pulmonary angiography with high sensitivity and almost perfect agreement.

To assess the diagnostic performance and interobserver agreement of CT pulmonary angiography (CTPA) in the detection of chronic thromboembolic pulmonary hypertension (CTEPH) and its features among radiologists of different levels of experience. In this retrospective, single-center, single-blinded study, three radiologists with different levels of experience in CT imaging (R1:15 years, R2:6 years, and R3:3 years) evaluated CTPA of 51 patients ultimately diagnosed with CTEPH (European Society of Cardiology guidelines) and 49patients without CTEPH in random order to assess the presence of CTEPH, its features in the pulmonary artery tree, proximal level of involvement, bronchial artery hypertrophy, mosaic perfusion, and right heart overload. CTPAs of 51 patients with CTEPH (median age, 66 years (IQR 56-72), 28 men) and 49 patients without CTEPH (median age, 65 years (IQR 50-74), 25 men) were evaluated. The sensitivity and specificity for the detection of CTEPH was 100% (all radiologists) and 100% (R1), 96% (R2), and 96%(R3) with almost perfect agreement (κ = 0.95). The sensitivity and specificity for detecting CTEPH by mosaic perfusion would be 89% (95%CI 83-93%) and 81% (74-87%). The level of pulmonary artery involvement was reported with moderate agreement (κ = 0.54, 95%CI 0.40-0.65). Substantial agreement was found in the evaluation of mosaic attenuation (κ = 0.75, 95%CI 0.64-0.84), right heart overload (κ = 0.68, 95%CI 0.56-0.79), and bronchial artery hypertrophy (0.71, 95%CI 0.59-0.82) which were the best predictors of CTEPH (p < 0.0001). CTPA has high sensitivity and specificity in detecting CTEPH and almost perfect agreement among radiologists of different levels of expertise. CT pulmonary angiography can be used as a first-line imaging modality in patients with suspected chronic thromboembolic pulmonary hypertension (CTEPH) even when interpreted by non-CTEPH experts. • CT pulmonary angiography has high sensitivity and specificity in detecting chronic thromboembolic pulmonary hypertension (CTEPH) and almost perfect interobserver agreement among radiologists of different levels of expertise. • Substantial agreement exists in the assessment of mosaic attenuation, right heart overload, and bronchial artery hypertrophy, which are the best predictors of CTEPH.

Does Bronchial Artery Hypertrophies After Descending Thoracic Aorta Stenting in Takayasu Arteritis? - A Clinical Dilemma.

41-year-old lady, known case of Takayasu arteritis with pulmonary arterial involvement, presented with multiple episodes of haemoptysis (maximum 50mL) in a week. She had undergone descending thoracic aorta angioplasty and stenting 3years ago due to uncontrolled hypertension, left ventricular systolic dysfunction and approximately 70% stenosis of descending thoracic aorta. This lady was treated with embolization of hypertrophied bronchial artery as well as left internal mammary artery branch for management of haemoptysis. Embolization of hypertrophied bronchial artery in the setting of Takayasu arteritis with pulmonary arterial involvement presenting with haemoptysis is rare. Hypertrophied bronchial artery detected in post stenting computed tomography raises suspicion whether descending thoracic aorta stenting promotes the hypertrophy of bronchial artery. Literature of bronchial artery embolization in the setting of Takayasu with post DTA stenting is scarce.

Effects of aqueous leaf extract of Mimosa pudica on insect repellent-induced injury in the lungs of adult Wistar rats

The aim of this study was to investigate the effects of aqueous leaf extract of Mimosa pudica in the lungs of adult Wistar rats exposed to insect-repellent mist. 30 adult Wistar rats were randomly assigned into 5 groups; group A-E comprising of 6 rats per group. Group A rats were placed on rat food and water only. Group B rats were exposed to insect repellant only via inhalation. Group C rats were given Mimosa pudica extract orally at 500mg/Kg body weight per day (BWT/D) and Group D rats were exposed to Mosquito repellent and received low dose of the plant extract at (250mg/kg BWT/D) and Group E rats were exposed to mosquito repellent and received (500mg/kg BWT/D) of extract. The dosages were given for 30 consecutive days via orogastric method. There was significant increase in body weight in all treated groups. The haematological outcome showed that insect repellent caused some derangements in haematological parameters especially haematocrit, plateletcrit and mean corpuscular hemoglobin concentration. Histologically, Group D showed an expanded lumen of the bronchioles and shrunken activated immune system. Group E showed a more activated immune system and contracted bronchial artery. Mosquito repellant induced vascular ulceration, bronchiolar mucosal ulceration and activated lymphoid tissue in Group B. These effects were reversed by Mimosa pudica leaf extract. In conclusion, Mimosa pudica had ameliorative effect against mosquito repellant induced injury in the lungs.

Endovascular treatment for massive haemoptysis due to pulmonary pseudoaneurysm: report of 23 cases

PurposeTo evaluate the safety and effectiveness of endovascular treatment for massive haemoptysis caused by pulmonary pseudoaneurysm (PAP).MethodsThe clinical data, imaging data, and endovascular treatment protocol of 23 patients with massive haemoptysis caused by continuous PAP were retrospectively analysed. The success, complications, postoperative recurrence rate, and influence of the treatment on pulmonary artery pressure were also evaluated.ResultsNineteen patients with a bronchial artery-pulmonary artery (BA-PA) and/or nonbronchial systemic artery-pulmonary artery (NBSA-PA) fistula underwent bronchial artery embolization (BAE) and/or nonbronchial systemic artery embolization (NBSAE) + pulmonary artery embolization (PAE). The pulmonary artery (PA) pressures before and after embolization were 52.11 ± 2.12 (35–69 cmH2O) and 33.58 ± 1.63 (22–44 cmH2O), respectively (P = 0.001). Four patients did not have a BA-PA and/or NBSA-PA fistula. Embolization was performed in two patients with a distal PAP of the pulmonalis lobar arteria. Bare stent-assisted microcoils embolization was performed in the other two patients with a PAP of the main pulmonary lobar arteries. The PA pressures of the four patients before and after treatment were 24.50 ± 1.32 (22–28 cmH2O) and 24.75 ± 1.70 (22–29 cmH2O), respectively (P = 0.850). The technique had a 100% success rate with no serious complications and a postoperative recurrence rate of 30%.ConclusionEndovascular treatment is safe and effective for massive haemoptysis caused by PAP. BAE and/or NBSAE can effectively reduce pulmonary hypertension in patients with a BA-PA and/or NBSA-PA fistula.

Elexacaftor/Tezacaftor/Ivacaftor Improves Bronchial Artery Dilatation Detected by Magnetic Resonance Imaging in Patients with Cystic Fibrosis.

Rationale: Magnetic resonance imaging (MRI) detects improvements in mucus plugging and bronchial wall thickening, but not in lung perfusion in patients with cystic fibrosis (CF) treated with elexacaftor/tezacaftor/ivacaftor (ETI). Objectives: To determine whether bronchial artery dilatation (BAD), a key feature of advanced lung disease, indicates irreversibility of perfusion abnormalities and whether BAD could be reversed in CF patients treated with ETI. Methods: A total of 59 adults with CF underwent longitudinal chest MRI, including magnetic resonance angiography twice, comprising 35 patients with CF (mean age, 31 ± 7 yr) before (MRI1) and after (MRI2) at least 1 month (mean duration, 8 ± 4 mo) on ETI therapy and 24 control patients with CF (mean age, 31 ± 7 yr) without ETI. MRI was assessed using the validated chest MRI score, and the presence and total lumen area of BAD were assessed with commercial software. Results: The MRI global score was stable in the control group from MRI1 to MRI2 (mean difference, 1.1 [-0.3, 2.4]; P = 0.054), but it was reduced in the ETI group (-10.1 [-0.3, 2.4]; P < 0.001). In the control and ETI groups, BAD was present in almost all patients at baseline (95% and 94%, respectively), which did not change at MRI2. The BAD total lumen area did not change in the control group from MRI1 to MRI2 (1.0 mm2 [-0.2, 2.2]; P = 0.099) but decreased in the ETI group (-7.0 mm2 [-8.9, -5.0]; P < 0.001). This decrease correlated with improvements in the MRI global score (r = 0.540; P < 0.001). Conclusions: Our data show that BAD may be partially reversible under ETI therapy in adult patients with CF who have established disease.

The clinical impact of Lumacaftor-Ivacaftor on structural lung disease and lung function in children aged 6–11 with cystic fibrosis in a real-world setting

BackgroundData from clinical trials of lumacaftor-ivacaftor (LUM-IVA) demonstrate improvements in lung clearance index (LCI) but not in FEV1 in children with Cystic Fibrosis (CF) aged 6–11 years and homozygous for the Phe508del mutation. It is not known whether LUM/IVA use in children can impact the progression of structural lung disease. We sought to determine the real-world impact of LUM/IVA on lung structure and function in children aged 6–11 years.MethodsThis real-world observational cohort study was conducted across four paediatric sites in Ireland over 24-months using spirometry-controlled CT scores and LCI as primary outcome measures. Children commencing LUM-/IVA as part of routine care were included. CT scans were manually scored with the PRAGMA CF scoring system and analysed using the automated bronchus-artery (BA) method. Secondary outcome measures included rate of change of ppFEV1, nutritional indices and exacerbations requiring hospitalisation.ResultsSeventy-one participants were recruited to the study, 31 of whom had spirometry-controlled CT performed at baseline, and after one year and two years of LUM/IVA treatment. At two years there was a reduction from baseline in trapped air scores (0.13 to 0.07, p = 0.016), but an increase from baseline in the % bronchiectasis score (0.84 to 1.23, p = 0.007). There was no change in overall % disease score (2.78 to 2.25, p = 0.138). Airway lumen to pulmonary artery ratios (AlumenA ratio) were abnormal at baseline and worsened over the course of the study. In 28 participants, the mean annual change from baseline LCI2.5 (-0.055 (-0.61 to 0.50), p = 0.85) measurements over two years were not significant. Improvements from baseline in weight (0.10 (0.06 to 0.15, p < 0.0001), height (0.05 (0.02 to 0.09), p = 0.002) and BMI (0.09 (0.03 to 0.15) p = 0.005) z-scores were seen with LUM/IVA treatment. The mean annual change from baseline ppFEV1 (-2.45 (-4.44 to 2.54), p = 0.66) measurements over two years were not significant.ConclusionIn a real-world setting, the use of LUM/IVA over two years in children with CF aged 6–11 resulted in improvements in air trapping on CT but worsening in bronchiectasis scores. Our results suggest that LUM/IVA use in this age group improves air trapping but does not prevent progression of bronchiectasis over two years of treatment.

Drug-eluting beads bronchial arterial chemoembolization vs. conventional bronchial arterial chemoembolization in the treatment of advanced non-small cell lung cancer.

To compare the effectiveness and safety of drug-eluting bead bronchial artery chemoembolization (DEB-BACE) with conventional bronchial artery chemoembolization (cBACE) and provide a novel treatment option for advanced non-small cell lung cancer (NSCLC). Patients with advanced NSCLC underwent DEB-BACE or cBACE and were screened retrospectively. Progression-free survival (PFS) and overall survival (OS) were the primary outcome indicators, while technical success rate, objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) were the secondary ones. A total of 41 patients were enrolled in the study, 12 in the DEB-BACE group and 29 in the cBACE group, according to the treatment regimen. No patient achieved complete response. Eighteen patients achieved partial response (9 in each group), 15 patients achieved stable disease (3 in the DEB-BACE group and 12 in the cBACE group), and eight patients achieved progressive disease (all in the cBACE group) when treated for 2 months. The overall ORR and DCR were 43.9% (18/41) and 80.5% (33/41), respectively. ORR and DCR in the DEB-BACE group were 50.0% (9/12) and 100.0% (12/12), respectively, while ORR and DCR in the cBACE group were 31.0% (9/29) and 72.4% (21/29), respectively. Compared to cBACE, the ORR and DCR of DEB-BACE were significantly improved (p < 0.05). The median PFS was better in the DEB-BACE group than in the cBACE group (6.95 months vs. 3.20 months, respectively, Hazard Ratio [HR] = 0.416; p = 0.005). Furthermore, the median OS was significantly better in the DEB-BACE group than in the cBACE group (28.5 months vs. 22.5 months, respectively, HR = 0.316; p = 0.020). DEB-BACE has a good safety and therapeutic profile in advanced NSCLC and is superior to cBACE. DEB-BACE can be used as an alternative treatment option for advanced NSCLC, even in elderly patients.

Arterial blood vessels of the lung of the Russian hound breed dogs in the age aspect

Such a breed of dog as the Russian Hound is the most popular breed among hounds in Russia. The average weight is 25 -35 kg, and at the withers it reaches up to 65 cm, representatives of this breed live up to 14-16 years. They are easily trained and are ideal hunting companions for hare and fox, during which they often suffer injuries in the chest cavity, and veterinarians face the difficult task of providing surgical care to such patients. Knowledge of the anatomical and topographic features of the arterial bed of the lungs is necessary when providing surgical care. During the formation of the functional activity of the body, the change in the diameter of the arterial bed is of particular interest. The purpose of the study was to study the arterial bed of the lungs of the Russian Hound breed in the age aspect, to give the arteries a morphometric characteristic. Three age groups of dogs were selected for the study: newborn puppies, puppies at the age of nine months, and mature dogs. Fine anatomical preparation, vasorentgenography, morphometry was chosen as research methods. During the study, morphometric data of such vessels as: pulmonary trunk, right and left pulmonary arteries, right and left bronchial arteries were obtained.

Dieulafoy’s disease of the bronchus: rare but potentially fatal: a case report and a review of literature

BackgroundDieulafoy’s disease of the bronchus can cause massive and even fatal hemoptysis. Even though it is rare, it should be considered by physicians all over the world. This paper reports a case of bronchial Dieulafoy’s disease and summarizes the data of similar cases reported in literature.MethodsWe report a case of bronchial Dieulafoy’s disease (BDD) in Tunisia. We also present a review of literature related to BDD from 1995 to 2022 using the PubMed, Google Scholar, web of science and Chinese National Knowledge Infrastructure Databases. Clinical characteristics, chest imaging, bronchoscopic and angiographic findings were summarized. Treatment courses were identified as well as patients’ outcome.ResultsWe report the case of a 41-year-old man, so far in good health, presenting with massive hemoptysis. Bronchoscopy showed blood clots and a protruding lesion covered by mucosa with a white pointed cap at the entrance of the right upper lobe. Biopsies were not attempted. Embolization of bronchial artery was first realized and was not successful, with post procedure complications. Surgical intervention stopped the bleeding and pathological examination of the resected specimen confirmed Dieulafoy’s disease of the bronchus. Ninety cases of BDD were reported from 1995 to 2022. The main symptom was hemoptysis. Chest imaging findings were not specific. The diagnosis of BDD was mainly based on the bronchoscopy, branchial angiography and pathological findings or surgical specimens. Bronchoscopy findings were mostly nodular or prominent lesions (52.4%). Twenty-eight patients underwent bronchoscopic biopsies, 20 had massive bleeding and 10 died. Bronchial angiography mainly showed tortuous and dilation of bronchial artery, and the lesions were mainly located in the right bronchus. Selective bronchial artery embolization (SBAE) was performed in 32 patients and 39 patients underwent surgery.ConclusionTo our knowledge, this is the first case of bronchial Dieulafoy’s disease to be reported in Tunisia and North Africa. When the diagnosis is suspected, bronchoscopic biopsy should be avoided as it might lead to fatal hemorrhage. Selective bronchial artery embolization can stop the bleeding, but surgery can be required.

Risk factors for the recurrence in pulmonary tuberculosis patients with massive hemoptysis.

To evaluate the outcomes of bronchial artery embolization (BAE) for the treatment of massive hemoptysis in patients with pulmonary tuberculosis and identify risk factors that influence recurrence. A total of 81 patients with massive hemoptysis who underwent BAE between January 2014 and December 2017 were retrospectively reviewed. All of the patients had either a history of pulmonary tuberculosis or a current diagnosis of pulmonary tuberculosis. Follow-up ranged from 18 to 66 months. Hemoptysis was stopped or markedly decreased, with subsequent clinical improvement in 73 patients, while 11 patients experienced recurrence during the follow-up period. Systemic-pulmonary shunts and clinical failure showed a statistically significant correlation with the recurrence rate. The cumulative non-recurrence rate was 95.3% for 3 months and 81.9% for more than 24 months. Complications were common (12.5%), but self-limiting. BAE is a safe and effective treatment option for the control of massive hemoptysis in pulmonary tuberculosis patients. Systemic-pulmonary shunts and clinical failure are the risk factors for recurrence.

Hemoptysis as the presenting manifestation of bronchiectasis-associated hospitalization in Korea.

Patients with bronchiectasis commonly experience disease exacerbations, which cause significant morbidity and mortality. However, data regarding the clinical features of bronchiectasis patients hospitalized with hemoptysis are scarce. We retrospectively collected the data of patients with bronchiectasis-associated hospitalization at a tertiary referral center in Korea, and classified them into the hemoptysis and infective exacerbation (IE) groups. The presence of hemoptysis was defined as a volume of expectorated blood larger than 10 mL per 24 hours. The clinical, radiological, and laboratory parameters were compared between the two groups. Patients were classified into the hemoptysis [267 (54.5%)] and IE [223 (45.5%)] groups. Among the 44 patients of the hemoptysis group, 37 (84.1%) presented with hemoptysis than with IE at the recurrent episode. The hemoptysis group had a significantly lower 30-day mortality than that of the IE group. Previous pulmonary tuberculosis (TB), mycetoma, and bronchial artery hypertrophy were independently associated with the hemoptysis group. In contrast, male sex, poor performance status, colonization of Pseudomonas aeruginosa, ≥3 involved lobes, cystic bronchiectasis, and emphysema were inversely associated with the hemoptysis group. The absence of hemoptysis was one of the independent predictors of 30-day mortality in patients with bronchiectasis-associated hospitalization. In Korea, bronchiectasis patients hospitalized with hemoptysis exhibit a distinct phenotype, and are more likely to have previous pulmonary TB, mycetoma, and bronchial artery hypertrophy. Hemoptysis is associated with a lower risk of short-term mortality compared to IE in bronchiectasis-associated hospitalization.

СТРУКТУРА БРОНХИАЛЬНЫХ АРТЕРИЙ КРЫС ПРИ ЧЕРЕПНО-МОЗГОВОЙ ТРАВМЕ И СИСТЕМНОМ ВОСПАЛЕНИИ

Purpose of the study: to present a histochemical and morphometric assessment of the state of the blood vessels of the bronchial tree and lung parenchyma of rats in experimental traumatic brain injury (TBI). and systemic inflammation caused by the administration of pyrogenal. Materials and methods. The experiment was carried out on mature male Wistar rats (200-250 g). Potentially painful interventions in the ongoing experiments and euthanasia were performed under combined injection anesthesia. The model of the falling weight modified by us for rats was used to reproduce TBI. To initiate systemic inflammation (SI), the animals were intramuscularly injected with pyrogenal solution. The study included the following groups: intact rats (n=12); after applying TBI (n=12)-TBI; triple administration (1, 3, 4 days) of pyrogenal without TBI (n=16)-SV; triple administration of pyrogenal (1, 3, 4 days) after TBI (n=12)-TBI+SV. On days 4 and 6 from the beginning of the experiment, under general anesthesia, the animals were dissected, their lungs were removed, after which histological sections were made. Morphological and functional changes in the blood vessels of the bronchial tree and lung parenchyma were analyzed in experimental traumatic brain injury (TBI) and systemic inflammation in rats. It has been established that in injured rats, the administration of pyrogenal has a significant effect on the structure of the bronchial blood vessels of the lungs, while the application of only TBI does not initiate such changes. At the same time, a significant change in the morphometric characteristics of blood vessels is detected, a spasm of arterioles is determined with a decrease in the diameter of the lumen on days 4 and 6 of the study, and an accumulation of segmented leukocytes, macrophages and other bronchial secretion cells in the perivascular space of the vessels is noted. Thus, the results of the study show that with the comorbidity of TBI and SI in the lungs, structural changes occur in the elastic framework of the distal bronchial arteries, which manifests itself changes in the structure of the elastic membranes of these blood vessels.

The HRCT Imaging Findings of the Peripheral Pulmonary Vessels in Patients with Pulmonary Hypertension (PH)

The prominence of the pulmonary vasculature and/or tortuosity (n = 16) and dilatation of the central PA (n = 39) with RV hypertrophy were frequently observed. The interlobular septal thickening (n = 18, 45%), and centrilobular (perivascular) ground glass opacities (n = 6, 15%) were clearly depicted on gapless HRCT. PA aneurysmal dilatation and irregular dilatation with arterio-venous fistula were observed in 2 (5%) and 3 cases (7.5%), respectively. Bronchial artery dilatation was observed in 5 cases.

Hemoptysis: unilateral pulmonary artery atresia? a case report

BackgroundAsymptomatic, isolated cases of unilateral pulmonary artery atresia may present in adulthood with symptoms such as recurrent respiratory infections, dyspnea, hemoptysis, and pulmonary hypertension. Unlike previously reported patients that underwent surgical management for this pathology, the patient in this report had no chronic history of recurrent respiratory infections, dyspnea, or pulmonary hypertension, making a diagnosis prior to extensive imaging difficult.Case presentationA 55-year-old male presented to our emergency department (ED) with a 3-day history of recurrent cough with 2–3 tablespoons of hemoptysis per episode, chills, and occasional wheezing. A computed tomography angiography (CTA) was performed, which identified a congenital absence of the left pulmonary artery and a right-sided aortic arch. Hypertrophied left intercostal and bronchial arteries were noted to be perfusing the left lung. V/Q scan confirmed a heterogeneous distribution of gas throughout both lung fields with 97% perfusion to the right lung, but no visualization of the left lung on the perfusion images. Given extensive collateral blood supply to the left lung, interventional radiology performed a GELFOAM® embolization of the hypertrophied left bronchial artery and two parasitized arteries from the left subclavian artery to minimize intra-operative blood loss. This was immediately followed by a left thoracotomy, pneumonectomy, intercostal muscle flap placement, and bronchoscopy. The procedure was 360 min long with a total of 1500 cc blood loss that was salvaged and re-infused. No additional blood products were administered. The patient remained intubated post-operatively and was transferred to the surgical intensive care unit. His postoperative course was complicated by troponin leak, rhabdomyolysis, delirium, and ileus, all of which resolved over time. He was discharged home on postoperative day seven and continues to do well one-year later.ConclusionsThe patient in this report presented with several episodes of isolated hemoptysis but unlike previously reported cases of unilateral pulmonary artery atresia, he had no history of recurrent respiratory infections, dyspnea, or pulmonary hypertension. Although unilateral pulmonary artery atresia is a rare diagnosis, in patients with unexplained, isolated hemoptysis, further examination of the vasculature may be warranted, and surgical management may be beneficial in appropriate, symptomatic patients.

A case of bronchial Dieulafoy disease and literature review

ObjectiveBronchial Dieulafoy's disease (BDD) is a rare disease that causes massive hemoptysis. This paper reports a case of BDD treated surgically. At the same time, we summarize the data of BDD patients reported in domestic and foreign literature to improve the understanding, diagnosis and treatment of this disease.MethodsA case of BDD with hemoptysis during bronchoscopy was reported. In addition, we searched for "bronchial Dieulafoy disease" through Pubmed, Web of Science, CNKI and Wanfang databases, covering the literature related to BDD that was definitely diagnosed or highly suspected from January 1995 to December 2021, and summarized the clinical characteristics, chest imaging, bronchoscopic manifestations, angiographic characteristics, pathological characteristics, treatment and outcome of patients.ResultsThe patient was a 68 year old male. Tracheoscopy revealed nodular and mass like changes in the basal segment of the left lower lobe, which appeared massive hemorrhage when touching the surface. The computed tomography angiophy of the bronchial artery confirmed that the branches of the left bronchial artery were tortuous and dilated, and then the left lower lobe of the lung was resected. During the operation, 3 thick tortuous nutrient artery vessels were sent out from the descending aorta, and 1 thick tortuous nutrient artery was sent out from the autonomic arch. All of them were ligated and cut. The pathology after the operation was in accordance with BDD; The patient did not have hemoptysis after discharge and is still under follow-up. The database identified 65 articles from January 1995 to December 2021. After removing repeated reports, meetings, incomplete information and nursing literature, 60 articles were included to report 88 cases of BDD. BDD can occur at all ages, with a male to female ratio of about 1.6:1. It mainly starts with hemoptysis, and can also be seen due to cough, infection, and respiratory failure; Inflammatory changes such as pulmonary patch shadow, exudation shadow and ground glass shadow of pulmonary hemorrhage were more common in chest imaging; The diagnosis of BDD is mainly based on the bronchoscopy, bronchial angiography and pathological findings of surgical or autopsy specimens. Bronchoscopic findings were mostly non pulsating, smooth nodular or mucosal processes. Bronchial angiography mainly showed tortuous dilatation of bronchial artery, and the lesions were mainly located in the right bronchus, more from the bronchial artery; Diagnosis depends on pathology, showing submucosal expansion of bronchus or abnormal artery rupture and bleeding; 54 cases underwent selective bronchial artery embolization, 39 cases underwent pulmonary lobectomy, 66 cases improved, and 10 cases died (all of them were caused by massive hemorrhage during bronchoscopic biopsy).ConclusionBDD is rare, but may cause fatal massive hemoptysis. Bronchial angiography is considered to be an effective method to diagnose BDD. Since pathological biopsy may lead to fatal bleeding, the necessity of pathological diagnosis remains controversial. Interventional and surgical treatment plays an important role in patients with cough accompanied by massive hemoptysis.

CT features of pulmonary ACTH-Secreting Tumor

The purpose of the study is to improve the accuracy of CT diagnostics of pulmonary ACTH-Secreting Tumor.Material and methods. During the period from 2010 to 2022 at the Endocrinology Research Centre and the National Medical Research Center of Surgery named after A. Vishnevsky of the Ministry of Health of Russia 23 patients with pulmonary ACTH-Secreting Tumor were examined and treated. CT-features were analyzed: localization, shape, contours, connection of the formation with the bronchus, connection of the formation with the vessel, adherence to the vessel and bronchus along the long axis, structure of the neoplasm. We also analyzed the largest size of the formation, the size of the largest regional lymph node, the density of the tumor on axial sections in the native, arterial, venous and delayed phases of the study.Results. In the study, we identified a new phenotypic CT sign – the relationship with the bronchovascular bundle. The connection with the bronchus and vessel was assessed in detail. In the majority of patients, the connection with the pulmonary vessels (in most cases with small bronchial arteries) was especially clearly noted: an intimate attachment of the tumor along its long axis to the vessel. Less often it was possible to trace the connection with the bronchus.Conclusion. ACTH-producing NET of the lung is most often a peripherally located oval-shaped formation with even/ lobulated contours, adjacent to the bronchovascular bundle along the long axis of the tumor, intensively enchancing (increase of density parameters by more than 40 HU compared with the unenhanced phase) in the venous, less often the arterial phase of bolus contrast enhancement.

Minimally invasive methods of treatment of pulmonary bleeding

&#x0D; &#x0D; &#x0D; pulmonary bleeding is a life-threatening complication of many diseases, pathological con- ditions and respiratory injuries. In connection with the urgency of the problem of the occurrence of pul- monary bleeding, in recent years, new highly effective methods of diagnosis and treatment of this com- plication have been increasingly used in clinical practice. The main principles of treatment of pulmonary bleeding are prevention of asphyxia and immediate stopping of bleeding. The range of treatment tactics is quite wide: from conservative treatment, temporary cessation of pulmonary bleeding for a period suf- ficient to remove patients from a serious condition, diagnosis of the underlying disease and preparation&#x0D; &#x0D; &#x0D; &#x0D; for radical surgery, to emergency elimination of this complication. To date, there is no consensus on a single universal method of diagnosis and treatment of pulmonary hemorrhage, therefore, in order to improve the effectiveness of diagnosis and further treatment of this complication, a systematic approach is recommended, which involves combining several methods. Endoscopic methods cannot in all cases accurately determine the source of bleeding, so they are recommended to be combined with radiological studies, CT, angiography of bronchial arteries. With massive pulmonary bleeding, more importance is attached to surgical intervention, which includes endovascular catheter embolization of bronchial ar-teries. X-ray endovascular occlusion is a minimally invasive and highly effective method of stopping all types of bleeding from the bronchial artery pool, which can be used even in extremely critical patients. Minimally invasive methods: endoscopic and endovascular are leading in the diagnosis and treatment of respiratory diseases complicated by pulmonary bleeding. They allow not only to establish the very fact of pulmonary bleeding and its likely source, but also to implement the entire set of measures aimed at stopping bleeding. Despite the reliability and demand of minimally invasive methods, the question of using one or another method to stop pulmonary bleeding remains unclear, which requires further study of their effectiveness, reliability, and economic validity.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;