Arterial Embolism Research Articles

Clinical characteristics and BGA-optimized pretest probability of pulmonary embolism in the elderly.

Pulmonary arterial embolism (PE) is not well characterized in elderly patients. In addition, unnecessary computed tomography pulmonary angiography (CTPA) examinations are often performed within this patient group, especially if the pretest probability is low. To identify differences in clinical presentation in patients aged ≥80 years compared to patients <80 years and the effect of a BGA-optimized pretest probability to reduce unnecessary CTPAs according to age category. Aretrospective analysis of patients with suspected PE and subsequent CTPA was performed, with evaluation of clinical data including capillary blood gas analysis (BGA) parameters (including standardized partial pressure of oxygen [sPaO2]) over a5-year period. Subsequently, the clinical characteristics of patients with confirmed PE were compared between the two age groups. In addition, an age-adjusted analysis of aBGA-optimized algorithm was performed in patients with alow pretest probability (PTP) according to the Wells score to reduce unnecessary CTPAs. PE was confirmed in 433 of 1538 patients with suspected PE, of which n = 98 (22.6%) were ≥ 80years of age. Elderly patients with PE were less frequently male (p < 0.001), had lower rates of tachycardia (p = 0.021), but higher rates of cardiovascular disease history (p = 0.001) and oxygen administration at admission (p = 0.006) compared to those < 80years. Signs of right heart dysfunction (p = 0.047) and elevated cardiac biomarkers (troponin: p < 0.001; nt-pro-BNP: p = 0.026) were also more common in the elderly. Additionally, simplified Pulmonary Embolism Severity Index (sPESI, p < 0.001) and in-hospital or 30-day death risk (p < 0.001) were higher in the elderly. Using aBGA-optimized algorithm with sPaO2, unnecessary CTPA examinations were reduced by 33.2% in younger patients (75of 226 without PE) and 23.5% in elderly patients (8of 34 without PE). Elderly patients with PE are characterized by higher clinical risk markers and elevated mortality rates compared to younger patients. In patients with suspected PE but low PTP, however, asignificant number of unnecessary CTPAs could be avoided by using an BGA-optimized pretest algorithm in elderly patients.

Thromboembolic prophylaxis in bariatric and metabolic surgery: state-of-the-art according to the results of a nationwide registry study.

The present study employed a large scaled multicenter nationwide study data analysis to elucidate the impact of thromboembolism prophylaxis (TEP) in the context of bariatric and metabolic surgery and to investigate the peri- and postoperative complications associated with TEP. A total of 63,909 patients who underwent primary bariatric surgery between 2005 and 2020 were included in the analysis. The data were collected prospectively and multicentrically in the German Bariatric Surgery Registry (GBSR) and subsequently analyzed retrospectively. A p value of ≤ 0.05 was deemed to correspond to a significant result. 96.65% of patients were prophylactically anticoagulated postoperatively. 99.3% of the anticoagulated patients received low molecular weight heparin on a median of 7days. With regard to postoperative complications, a significantly higher incidence of transfusion (p < 0.001) or postoperative bleeding requiring surgery (p = 0.002) was observed in the group of patients who underwent TEP. At 0.67% and 0.87% respectively, these were nevertheless rare complications. The incidence of deep vein thrombosis (DVT) (TEP n = 46, no TEP n = 1; p = 0.642) and pulmonary artery embolism (PAE) was 0.1% each (TEP n = 57, no TEP n = 2; p = 0.985). The surgical technique was associated with a minimal risk of consequences for DVT. Here was the occurrence of DVT following surgical procedures in patients with TEP 0.1% for gastric banding (GB) and sleeve gastrectomy (SG), and less than 0.1% for Roux-Y gastric bypass (RYGB). The mortality rate was between patients with TEP and patients without TEP not significantly different (n [TEP] = 102; 0.17%, n [no TEP] = 6; 0.28%) (p = 0.198). The study's findings validate the efficacy of TEP in bariatric surgery. However, to prevent adverse TEP consequences, like hemorrhage, the dosage and timing of prophylactic medication must be appropriately modified.However, it is evident that randomized controlled trials are necessary to establish uniform, high-quality recommendations on TEP.

Correlation between Efficacy and Cardiovascular Adverse Events in Patients with Advanced Solid Cancer Who Received VEGF Pathway Inhibitors: Hypertension within the First Eight Weeks Is Associated with Favorable Outcomes of Patients Treated with VEGF Pathway Inhibitors.

Objective Many vascular endothelial growth factor (VEGF) pathway inhibitors are used in the treatment of patients with various advanced cancers; however, treatments induce cardiovascular adverse events (CVAEs), such as hypertension, heart failure, arrhythmia, arterial or venous embolism, and hemorrhage. Some studies have suggested a correlation between efficacy and CVAEs; however, further evidence is required. This study evaluated real-world data concerning the frequency and degree of CVAEs and possible associations between CVAEs and efficacy in such patients. Methods We analyzed CVAEs observed in 294 patients with advanced cancer who were treated with ramucirumab, regorafenib, pazopanib, sunitinib, or sorafenib. Results CVAEs of any grade and proteinuria within 8 weeks after the initiation of VEGF pathway inhibitors (early) or during the treatment period (total period) were observed in 72-85% and 77-92% of the patients, respectively. The progression-free survival (PFS) of patients with a CVAE of grade ≥1 in the early period was favorable compared with the PFS of those who had no CVAE (median, 4.9 vs. 3.5 months, p=0.016, log-rank test). Furthermore, the PFS of patients with a CVAE grade ≥3 in the early period was favorable compared to that of those with CVAEs of grades 0-2. Taken together, a higher degree of CVAE was correlated with favorable patient outcomes. Conclusion This study revealed the frequency and degree of CVAEs in patients with solid cancers who received VEGF pathway inhibitors in a real-world setting and added evidence regarding the correlation between CVAEs and efficacy of VEGF pathway inhibitors.

A predictive clinical-radiomics nomogram for early diagnosis of mesenteric arterial embolism based on non-contrast CT and biomarkers.

Mesenteric artery embolism (MAE) is a relatively uncommon abdominal surgical emergency, but it can lead to catastrophic clinical outcomes if the diagnosis is delayed. This study aims to build a prediction model of clinical-radiomics nomogram for early diagnosis of MAE based on non-contrast computed tomography (CT) and biomarkers. In this retrospective study, a total of 364 patients confirmed as MAE (n = 131) or non-MAE (n = 233) who were randomly divided into a training cohort (70%) and a validation cohort (30%). In the training cohort, the minimum redundancy maximum relevance (mRMR) and the least absolute shrinkage and selection operator (LASSO) algorithms were used to select optimal radiomics features from non-contrast CT images for calculating Radscore which was utilized to establish the radiomics model. Logistic regression analysis was performed to screen clinical factors, and then generate the clinical model. A predictive nomogram model was built using Radscore and the selected clinical risk factors, which was evaluated through the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA). Thirteen radiomics features were chosen to calculate Radscore. Age, white blood cell (WBC) count, creatine kinase (CK) and D-dimer were determined as the independent clinical factors. The clinical-radiomics nomogram model showed the best performance in training cohort. The nomogram model was with higher area under curve (AUC) value of 0.93, compared to radiomics model with AUC value of 0.90 or clinical model with AUC value of 0.78 in the validation cohort. The calibration curve showed that nomogram model achieved a good fit in both cohorts (P = 0.59 and 0.92, respectively). The DCA indicated that nomogram model was significantly favorable for clinical usefulness of MAE diagnosis. The nomogram provides an effective tool for the early diagnosis of MAE, which may play a crucial role in shortening the time for therapeutic decision-making, thereby reducing the risk of intestinal necrosis and death.

Lipid-Lowering Drugs and Pulmonary Vascular Disease: A Mendelian Randomization Study.

The therapeutic value of lipid-lowering drugs in pulmonary vascular disease remains uncertain due to insufficient studies and evidence. This study aims to investigate the causal effects of lipid-lowering drugs (specifically, inhibitors of APOB, CETP, HMGCR, NPC1L1, and PCSK9) on pulmonary vascular diseases using a Mendelian randomization (MR) approach. We utilized summary-level statistics from genome-wide association studies (GWAS) to simulate the exposure to low-density lipoprotein cholesterol (LDL-C) and its outcomes on pulmonary arterial hypertension (PAH), pulmonary embolism (PE), and pulmonary heart disease (PHD). Single-nucleotide polymorphisms (SNPs) within or near drug target-associated LDL-C loci were selected as proxies for the lipid-lowering drugs. Data from the FinnGen cohort and UK Biobank (UKB) were incorporated to enhance the robustness and generalizability of the findings. The inverse variance weighted (IVW) and MR-Egger methods were employed to estimate MR effects. Our MR analysis indicated that LDL-C mediated by NPC1L1 (odds ratio [OR] = 104.76, 95% confidence interval [CI] = 2.01-5457.01, p = 0.021) and PCSK9 (OR = 10.20, 95% CI = 3.58-29.10, p < 0.001) was associated with an increased risk of PAH. In contrast, LDL-C mediated by APOB was associated with a decreased risk of PE (FinnGen: OR = 0.74, 95% CI = 0.60-0.91, p = 0.005; UKB: OR = 0.998, 95% CI = 0.996-1.000, p = 0.031) and PHD (FinnGen: OR = 0.73, 95% CI = 0.59-0.91, p = 0.004). However, LDL-C mediated by CETP and HMGCR did not show significant associations with the risks of PAH, PE, or PHD. This MR study revealed the causal effects of NPC1L1 and PCSK9 inhibitors on increased PAH risk, while APOB inhibitors appear to reduce the risks of PE and PHD. These findings enhance our understanding of the potential roles of lipid-lowering drugs in pulmonary vascular disease.

Isolated Right Ventricular Myocardial Infarction Due to Coronary Artery Embolism

Isolated Right Ventricular Myocardial Infarction Due to Coronary Artery Embolism

Arch of Aorta Cannulation through Right Internal Jugular Vein Causing Brachial Artery Embolism: A Rare Case

Arch of Aorta Cannulation through Right Internal Jugular Vein Causing Brachial Artery Embolism: A Rare Case

Polyurethane‐Based Bioglue for the Repair of Arterial Ruptures

AbstractA bioglue with fast blood absorption and strong adhesion, capable of stopping bleeding through physical blockage rather than coagulation, is imperative for treating arterial hematorrhea during surgery and in wilderness first aid. Here, we developed a two‐component polyurethane‐based arterial glue (PAG). The key strategy of this work is to optimize the hydrophilicity and crosslinking density of the bioglue by modulating the proportion of hydrophilic polyethylene glycol (PEG)‐based urethane prepolymer, the hydrophobicamine crosslinkers, and the functionality of the crosslinkers. Compared with commercial PEG‐based bioglue, PAG has a similar water absorption rate but less swelling. Furthermore, owing to the hydrogen bonding originating from the urethane/urea bonds and extracovalent bond formation with tissue, PAG showed ≈2 times greater adhesive strength than commercial PEG‐based bioglues. In addition, PAG has good hemocompatibility and maintains cured integrity even under circulating blood flushing conditions, thereby reducing the risk of arterial embolism. This bioglue demonstrated a more reliable sealing effect with a higher survival rate compared to commercial fibrin and PEG‐based bioglues on the rat abdominal aorta and rabbit carotid artery in open operations; moreover, it can be assembled into a commercial balloon dilation catheter system, enabling minimally invasive surgeries on the porcine femoral artery.

Genetic Determinants of Left Atrial Function Are Associated With Stroke.

While atrial fibrillation (AF) is a key risk factor for stroke, recent studies have suggested that atrial cardiomyopathy may also increase stroke risk in the absence of AF. This study aimed to evaluate genetic determinants for left atrial (LA) function and volumes and risk of stroke. Polygenic scores (PGSs) for LA measures were constructed and used in 380 017 individuals in the UK Biobank, without history of ischemic stroke, systemic arterial embolism, or AF at enrollment. Risk of ischemic stroke was estimated using time-to-event models, considering all-cause death and incident AF as competing events. Systemic arterial embolism was investigated as a secondary end point. The PGS for LA passive emptying fraction was associated with risk of ischemic stroke. Individuals with a PGS for LA passive emptying fraction in the lowest quartile had a hazard ratio (HR) of 1.12 for ischemic stroke compared with those in the top quartile (P=0.004). These associations were robust in a subgroup free of prevalent cardiovascular disease at baseline (HR for lowest quartile versus top quartile, 1.22; P<0.001). No associations were found for 4 other PGSs for LA measures or for risk of systemic arterial embolism. Two-sample Mendelian randomization was conducted between LA measures and cardioembolic stroke and indicated a protective effect of higher LA functional measurements. The PGS for LA passive emptying fraction was significantly associated with incident ischemic stroke when considering AF as a competing risk. Consistent results were found in Mendelian randomization analyses. These findings suggest that atrial dysfunction may influence stroke risk independently of AF.

Coronary Artery Embolism Secondary to Q Fever Endocarditis.

Coronary Artery Embolism Secondary to Q Fever Endocarditis.

Lung autotransplantation for advanced central lung cancer after neoadjuvant immuno-chemotherapy: a case series study.

For locally advanced central lung cancer, lung autotransplantation allows for complete tumor resection while maximizing the preservation of lung parenchyma. Neoadjuvant chemotherapy combined with immunotherapy has shown benefits for patients with advanced lung cancer, providing longer progression-free survival compared to chemotherapy alone. This study aims to evaluate the feasibility and safety of neoadjuvant immuno-chemotherapy followed by lung autotransplantation in the treatment of locally advanced central non-small cell lung cancer (NSCLC). We retrospectively analyzed ten patients with central NSCLC who underwent lung autotransplantation after neoadjuvant immuno-chemotherapy from June 2019 to December 2023. Of the grafts, there was 1 right upper lobe, 3 right lower lobe, 1 left lower lobe, 5 basal segments (3 right and 2 left). Nine cases were performed ex situ except one in situ without graft perfusion. All patients were followed up regularly. Ten cases received neoadjuvant immuno-chemotherapy [programmed cell death protein 1 (PD-1) inhibitor combined with platinum plus paclitaxel], the average number of cycles was 2.3±0.5 cycles, and the average interval between neoadjuvant therapy and surgery was 35.0±13.3 days. Following treatment, there was 1 complete response (CR), 6 partial responses (PRs), and 3 stable diseases (SDs). All cases achieved R0 resection, with 6 cases attaining complete pathological remission (CPR) and 2 cases exhibiting major pathological remission (MPR). No operative death occurred within 30 days. Six cases developed perioperative complications, with five cases being mild to moderate in severity, all of which recovered after standardized treatment. Only one instance of severe pulmonary artery embolism was observed, which improved with systemic anticoagulation therapy. The median follow-up time was 9.5 (range, 1.1-54.2) months. One patient had 4R lymph node recurrence (improved after radiotherapy and immunotherapy), and seven patients survived without recurrence. Lung autotransplantation for advanced central NSCLC after neoadjuvant immuno-chemotherapy is feasible and safe, with maximal preservation of lung function and a high rate of R0 resection. This also demonstrates the advantages of organ preservation strategies. The procedure can be technically challenging, but lethal complications are uncommon. Overall, outcomes are satisfactory, and patients achieved reasonable survival during the follow-up period.

Causal association between epigenetic age acceleration and two pulmonary vascular diseases: pulmonary arterial hypertension and pulmonary embolism—a bidirectional Mendelian study

BackgroundPulmonary arterial hypertension (PAH) is a relatively rare but severe disease with a poor prognosis. Pulmonary embolism (PE) is a serious condition that can cause sudden death. Epigenetic age acceleration (EAA) is a robust indicator derived from the DNA methylation-based epigenetic clock, which can predict the extent of aging. It has been proved that the epigenetic clock and EAA are associated with many cardiovascular diseases, while their associations with PAH and PE remain inconclusive. Our study aims to investigate the associations among these factors.MethodBy harnessing summary-level data from large-scale genome-wide association studies (GWAS), we designed a two-sample bidirectional Mendelian randomization (MR) analysis to assess the causal associations between measures of three epigenetic clocks, including GrimAge acceleration (n = 34,467), Hannum Age acceleration (n = 34,449) and PhenoAge acceleration (n = 34,463) and PAH (including 125 cases and 162,837 controls), as well as PE (including 3940 cases and 480,658 controls). The inverse variance-weighted (IVW) method was used as the primary method for MR analysis. Other methods, such as MR egger and weighted mode, served as complements to the IVW approach, were also applied in the analyses. Then, the MR pleiotropy test and MR-PRESSO test, which are effective tools for quality control of MR analysis, were subsequently used to ensure the accuracy of the study.ResultsThe forward MR analysis indicated that all three epigenetic clocks had no significant effects on PAH or PE. The reverse analysis indicated that the onset and progression of PAH and PE had insignificant effects on three epigenetic clocks. The results of the quality control assessment confirmed that our findings were reliable.ConclusionOur two-sample bidirectional MR analysis suggested that there is no significant association between epigenetic clocks and these two pulmonary vascular diseases.

Acute Superior Mesenteric Artery Embolism With Infective Endocarditis: Is There a Role for Endovascular Treatment?

The purpose of this article is to report a case of acute superior mesenteric artery embolism due to infective endocarditis treated with endovascular therapy. A patient with infective endocarditis was admitted to the hospital with abdominal pain, and abdominal enhanced computer tomography showed acute superior mesenteric artery embolism. He underwent urgent percutaneous mechanical thrombectomy and stenting to open the superior mesenteric artery and restore blood supply to the intestine. However, 17 days after the endovascular treatment, a pseudoaneurysm formed next to the stent, which was eventually removed by open surgery. The patient's prognosis was good at the 1 year follow-up. Endovascular treatment of acute superior mesenteric artery embolism caused by infective endocarditis was able to rapidly restore the intestinal blood supply. However, the possibility of postoperative pseudoaneurysm needs to be guarded against. This study will provide clinical treatment guidance for acute superior mesenteric artery embolism caused by infectious endocarditis. Endovascular treatment may rapidly alleviate intestinal ischemia and reduce the risk of intestinal necrosis, but it cannot completely eliminate infectious emboli, which may lead to further development of pseudoaneurysms.

Interval inhalation application of an oxygen-helium mixture reverses the effects of cerebral arterial air embolism

Oxygen-helium mixture demonstrates marked efficacy of helium mixtures in animal models of ischemia/reperfusion, which opens the possibility of its use as an emergency measure for therapy of vascular embolism. We modelled cerebral arterial air embolism by injecting an air bubble into the internal carotid artery of awake rats. Inhalation of a heated oxygen-helium mixture immediately after modelling arterial embolism normalizes physiological abnormalities and prevents ischemic brain damage, whereas application of a heated oxygen-helium mixture 2 hours after modelling arterial embolism significantly worsens the condition of the animals.

Postoperative Hemorrhage and Venous Thromboembolism in Patients with Pituitary Adenomas Under Acetylsalicylic Acid.

Background/Objectives: Postoperative hemorrhages (POHs) after pituitary adenoma surgery can have devastating consequences for patients. Many patients take acetylsalicylic acid (ASA) for the primary or secondary prevention of cardiovascular or stroke events. However, the impact of continued low-dose ASA use on the risk of postoperative hemorrhage and the frequency of thromboembolic events after discontinuing ASA in these patients remain poorly understood. This study aims to investigate the potential interaction and correlation between low-dose ASA intake and two of the most common complications after neurosurgical surgery-acute postoperative hemorrhage and thromboembolism. Methods: A retrospective study involving 1862 patients who underwent brain tumor surgery over a decade at our neurosurgical institute examined the risk of postoperative hemorrhage and thromboembolic events. The study compared bleeding rates in patients with pituitary adenomas who received low-dose ASA medication to those who did not. Additionally, the study investigated the occurrence of venous thromboembolism (VTE) or arterial pulmonary embolisms (PEs) following surgery, as well as the impact of laboratory parameters, demographic characteristics and intraoperative factors. Results: A total of 108 patients underwent surgery for primary pituitary tumors between January 2008 and January 2018. Only six patients (5.6%) experienced POH. Among those with POH, just two (1.9%) required revision surgery due to neurological decline. Interestingly, none of the 13 patients (12%) taking ASA preoperatively suffered POH. No correlation was found between laboratory results, demographics and postoperative complications. The study also did not find an increase in VTE or PE events. Conclusions: In this analysis, the perioperative intake of low-dose ASA could not be associated with an increased rate of hemorrhagic complications following pituitary adenoma surgery. Low-dose ASA can be safely continued during brain tumor surgery in patients with a high cardiovascular and cerebrovascular risk.

Use of a Hyperoxic Heated Helium-Oxygen Mixture in an Experimental Model of Cerebral Arterial Air Embolism

Use of a Hyperoxic Heated Helium-Oxygen Mixture in an Experimental Model of Cerebral Arterial Air Embolism

Safety Optimization of Injections in Specific Areas of the Scalp: A Cadaveric and 3D-CT Analysis of Arterial Distribution.

An injection method called cranial ceiling elevation is used in Asian countries to reduce facial proportions. Scalp injections carry risks such as arterial embolism or compression, leading to adverse events including scalp necrosis and hair loss. No arterial studies or injection recommendations exist for the injection of specific scalp regions. We aimed to examine blood vessel types and distributions to identify relatively safe areas for scalp injections. Computed tomography scans were used to evaluate the blood vessels in the scalp of 50 cadaver heads and anatomical studies were performed. Each scalp was divided into two segments (L1/L2) and six areas (S1/S1'-S3/S3'). The total number of arteries and the probability of each named artery occurring in each section were recorded. The total number of arteries in L1 was higher than that in L2 (L1, 78.76 ± 31.07; L2, 75.28 ± 28.68). The most frequently distributed artery in both L1 and L2 was the parietal branch of the superficial temporal artery. No significant difference was observed between the total number of arteries and the number of each named artery in the S1/S1'-S3/S3' segments. Except for S2' and S3', the number of named arteries in L1 was higher than that in L2. Large-volume scalp injections are not recommended. For injections within 30° above the ear, it is advisable to inject at L2. For other regions, it is also recommended to inject at L2. The periosteal layer should be selected for injection.

A Retrospective Claims Analysis of the Rate of Complications in Patients Undergoing Treatment for Paroxysmal Nocturnal Hemoglobinuria.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare blood disease associated with complications that increase morbidity, such as thrombosis and chronic kidney disease. Limited data exist regarding complications among treated patients outside of clinical trials, especially for patients treated with ravulizumab. This study leverages MarketScan claims data to examine the rate of complications in patients receiving PNH treatment. Patients with a diagnosis code of PNH [International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnosis code: D59.5] between October 2015 and December 2020, aged≥18 on the date of diagnosis, who had a≥6-month follow-up period of continuous enrollment and≥1 PNH-indicated treatment on or after the first PNH diagnosis were included. Among 211 patients diagnosed with PNH being treated with eculizumab or ravulizumab between October 2015 and December 2020, the most common complications were iron deficiency (20.4% of patients), arterial embolism and thrombosis (16.1%), and chronic kidney disease (11.8%). Overall, 44.1% of patients experienced≥1 complication. The high number of patients with PNH receiving treatment who nevertheless experienced complications demonstrates significant unmet medical need. Further analysis with larger sample sizes and including newer therapies, such as pegcetacoplan and iptacopan, is required to fully understand the scope and magnitude of this unmet need.

Potential new treatment for inferior vena cava injury using extracorporeal membrane oxygenation applying flow diversion effect

BackgroundRetrohepatic inferior vena cava (IVC) injuries remain among the most lethal and serious liver injuries. Gauze packing is currently the first choice for IVC injuries; however, laparotomy itself poses the risk of circulatory collapse. Thus, less invasive treatment strategies are needed.MethodsIn this study, we conducted an animal experiment to replicate and validate successful treatments for an actual case of retrohepatic IVC injury that we had encountered.ResultsA woman in her 80s presented to our hospital due to cardiac arrest caused by a pulmonary artery embolism. Venoarterial extracorporeal membrane oxygenation (ECMO) was introduced, and the patient was resuscitated. After resuscitation, contrast-enhanced CT revealed liver and retrohepatic IVC injuries, possibly caused by chest compressions. Liver injury was treated using transarterial embolization of the left hepatic artery. To treat the retrohepatic IVC injury, ECMO flow was increased to enhance the negative drainage pressure. The extravasation of the contrast medium had resolved in IVC angiography, and we opted for nonoperative management. The patient’s hemodynamic status gradually stabilized, and ECMO was withdrawn on day 6. We confirmed these findings in a dog model of retrohepatic IVC injury.ConclusionsOur findings from the patient and the animal model suggest that the flow diversion effect of ECMO can effectively manage active bleeding from the IVC by inserting a drainage cannula across the injured lesion. We think this procedure represents a novel treatment option for retrohepatic IVC injuries.

Persistent left superior vena cava with confluence into the left atrium: Missing contrast of the pulmonary arteries in the computed tomographic pulmonary angiography in a patient with pulmonary artery embolism

Persistent left superior vena cava with confluence into the left atrium: Missing contrast of the pulmonary arteries in the computed tomographic pulmonary angiography in a patient with pulmonary artery embolism