Pulmonary Artery Enlargement Research Articles

Prospective evaluation of the extensibility of the ascending aorta wall and its vascular prosthesis in a patient with an aneurysm with technically flawless surgical correction and postoperative decrease in functional parameters: A case report

In this clinical case, a patient who had an instrumentally detected aneurysm with the lumen expanding up to 60 mm underwent a surgically flawless prosthetic replacement of the ascending aorta. This treatment led to decreased exercise tolerance, decreased contractile function of the left ventricular myocardium at rest, and enlarged pulmonary artery. The leading factor was a decrease in the volume of systolic expansion of the aorta down to 5 mL (at the initial 13 mL), despite a noticeable increase in the extensibility and a decrease in mechanical stiffness compared with initial indexes of the affected aortic wall. In the literature review, considering mechanical extensibility and elasticity, problems in creating aortic prostheses equivalent to those for healthy biological tissues were discussed.

First case of autochthonous Angiostrongylus vasorum infection in a Norwegian dog

A fifteen-month-old Pembroke Welsh corgi with respiratory distress, exercise intolerance, and moderate regenerative anemia was referred to The Norwegian University of Life Sciences, Small Animal Hospital.Hematology revealed moderate regenerative anemia without evidence of hemolysis. Thoracic radiographs showed a generalized mixed interstitial to alveolar lung pattern and enlarged pulmonary arteries. Changes suggestive of moderate pulmonary hypertension were noted on echocardiography. Baermann fecal diagnostic flotation identified large numbers of Angiostrongylus vasorum larvae, and the AngioDetect serological antigen test was positive. The dog was treated with a two-week course with fenbendazole (51 mg/kg q24h po) and topical imidacloprid/moxidectin (250 mg/62.5 mg) and a one-week course with sildenafil (0.45 mg/kg q12h po). Complete clinical, clinicopathological and echocardiographic resolution was observed after only four weeks. Rapid improvement of echocardiographic abnormalities in cases with suspected pulmonary hypertension is not usually reported in cases with angiostrongylosis.Infection with A. vasorum should be considered in dogs with respiratory signs and bleeding tendencies, even in countries with no endemic history or reported cases.

Retrospective evaluation of a right heart parameter score in the assessment of precapillary pulmonary hypertension in dogs (2017-2021): 135 cases.

To determine if emergency and critical care residents can identify moderate to severe precapillary pulmonary hypertension on cardiologist-obtained cineloops using a pulmonary hypertension score (PHS) and report the interobserver variability of the PHS. Multicenter, retrospective, case-control study from 2017 to 2021. Private referral center and veterinary teaching hospital. One hundred and thirty-five client-owned dogs that underwent diagnostic echocardiography. None. Medical records of dogs with stage B1 myxomatous mitral valve disease (MMVD) and dogs diagnosed with precapillary pulmonary hypertension (PCPH) via echocardiograms were reviewed. Dogs were categorized by a cardiologist into 5 groups (normal, B1 MMVD, mild, moderate, and severe PCPH) based on Doppler pulmonary pressure gradients and right heart morphology. Cineloops from each case were subjectively evaluated by emergency and critical care residents for the presence of right atrial and ventricular enlargement, right ventricular hypertrophy, interventricular septal flattening, and pulmonary artery and trunk enlargement to form a composite pulmonary hypertension score out of 8 (PHS8). When available, signs of peritoneal effusion and distention of the caudal vena cava were subjectively assessed to generate a pulmonary hypertension score out of 10 (PHS10). There was excellent discrimination of moderate to severe PCPH versus grouped absent to mild PCPH using PHS8 (area under the receiver operator curve [AUC] [95% confidence interval, CI]=0.90 [0.84-0.95], P<0.0001) and PHS10 (AUC [95% CI]=0.89 [0.81-0.97], P<0.0001). PHS8≥3 was 64% sensitive and 98% specific for moderate to severe PCPH (positive likelihood ratio [LR+] 32, negative likelihood ration [LR-] 0.37). PHS10≥3.3 was 64% sensitive and 92% specific for moderate to severe PCPH (LR+ 8, LR- 0.39). Interobserver agreement was good to excellent (intraclass correlation coefficient [ICC]=0.74 [95% CI: 0.66-0.80], n=135). Residents identified moderate to severe PCPH in dogs using PHS on cineloops previously obtained by a cardiologist. The interrater agreement was good to excellent with limited training. Prospective studies to determine if residents can obtain diagnostic images for PHS are warranted.

Beyond pulmonary embolism: Alternative diagnosis and incidental findings on CT pulmonary angiography in sickle cell disease.

Sickle cell disease (SCD) is a genetic hematological disorder associated with severe complications, such as vaso-occlusive crises, acute chest syndrome (ACS), and an increased risk of thromboembolic events, including pulmonary embolism (PE). The diagnosis of PE in SCD patients presents challenges due to the overlapping symptoms with other pulmonary conditions. Our previous study revealed that nearly 96% of computed tomography pulmonary angiography (CTPA) scans in SCD patients were negative for PE, highlighting a gap in understanding the significance of CTPA findings when PE is absent. In this retrospective follow-up study conducted at the Salmaniya Medical Complex in Bahrain, we examined SCD patients with HbSS genotypes who underwent CTPA from January 1, 2018, to December 31, 2021, for suspected PE, but the results were negative. The aim of this study was to identify alternative diagnoses and incidental findings from CTPA scans. Experienced radiologists reviewed the CTPA images and reports to assess potential alternative diagnoses and incidental findings, incorporating an additional analysis of chest X-rays to evaluate the diagnostic value of CTPA. Incidental findings were classified based on their location and clinical significance. Among the 230 evaluated SCD patients (average age 39.7 years; 53% male) who were CTPA negative for PE, 142 (61.7%) had identifiable alternative diagnoses, primarily pneumonia (49.1%). Notably, 88.0% of these alternative diagnoses had been previously suggested by chest radiographs. Furthermore, incidental findings were noted in 164 (71.3%) patients, with 11.0% deemed clinically significant, necessitating immediate action, and 87.8% considered potentially significant, requiring further assessment. Notable incidental findings included thoracic abnormalities such as cardiomegaly (12.2%) and an enlarged pulmonary artery (11.3%), as well as upper abdominal pathologies such as hepatomegaly (19.6%), splenomegaly (20.9%), and gallstones (10.4%). This study underscores the limited additional diagnostic yield of CTPA for identifying alternative diagnoses to PE in SCD patients, with the majority of diagnoses, such as pneumonia, already suggested by chest radiographs. The frequent incidental findings, most of which necessitate further evaluation, highlight the need for a cautious and tailored approach to using CTPA in the SCD population.

Chest CT Scan Features of COVID-19 in a Hospitalized High-Altitude Population

There is a lack of knowledge regarding the type of lung compromise in high-altitude residents with COVID-19. This study aims to evaluate the lung compromise in chest CT scans of high-altitude dwellers hospitalized with COVID-19. Retrospective study that took place in "Daniel Alcides Carrión" Regional Hospital, located 3,250 meters above sea level in the city of Huancayo, Perú. 464 medical charts and chest CT images of hospitalized patients with confirmed COVID-19 from January to March 2021 were reviewed. The mean age was 56 years, 63.1% of the patients were male, and 85.8% of individuals had a CORADS 5. Ground glass infiltrates were found in 93.8% of the patients; alveolar consolidations were present in 86% and were usually bilateral. Thickened septa were described in 46%, lattice pattern in 38.8%, reticular components in 39%, and the crazy paving pattern in 36.9%. Most patients (84.5%) had central and peripheral lesions; only 4% had limited peripheral compromise, and 10% solely central distribution. The left posterior basal segment was the most affected pulmonary segment in 27% of the cases, and the right basal posterior in 26%. Less affected segments were the right and left apical (14% and 13%, respectively). Lung compromise in patients with COVID-19 in this high-altitude population was severe, with mostly bilateral compromise, increased diameter of the pulmonary artery, periaortic and subaortic lymph nodes enlargement, and extensive ground glass and alveolar lesions.

Indicators for pulmonary hypertension in dogs with degenerative mitral valve disease.

Pulmonary hypertension (PH) is a common complication of degenerative mitral valve disease (DMVD) in dogs. This study aimed to determine PH indicators in dogs with stage C DMVD through thoracic radiography and M-mode and 2-dimensional echocardiography. A retrospective study of 133 dogs with DMVD stage C was conducted. The patients were divided into two groups: DMVD and DMVD with PH. Characteristics, thoracic radiographic findings, and echocardiographic variables were recorded for analysis. Pulmonary hypertension was diagnosed in 56 dogs, with a prevalence of 42.1%. Univariable logistic regression analysis revealed associations among PH and right-sided heart enlargement, pulmonary artery enlargement, left ventricular size, and percent fractional shortening. Multivariable logistic regression analysis demonstrated that pulmonary artery enlargement (odds ratio [OR]: 5.96; 95% confidence interval [CI]: 1.45-24.54; p = 0.014) and decreased left ventricular size (OR: 0.02; 95%CI: 0.003-0.13; p = 0.001) were significantly associated with PH. The accuracy of predicting PH in dogs at DMVD stage C using pulmonary artery enlargement combined with decreased left ventricular size was moderate (area under the curve [AUC] 0.77; 95%CI: 0.68-0.86). Pulmonary hypertension is common in dogs with DMVD stage C. The presence of pulmonary artery enlargement assessed by radiography and decreased left ventricular size assessed by echocardiography, were associated with PH and may serve as predictors of PH in DMVD stage C.

Abstract 17708: Cardiac Nut-Cracker: Paroxysmal Left Main Coronary Compression by Inducible Pulmonary Trunk Dilatation in Pulmonary Hypertension

Case Presentation: A 56yo woman with a 12-year history of idiopathic pHTN and severe RV dysfunction presented with worsening exertional angina (CCS III). Perfusion imaging demonstrated a large apical-septal defect, corresponding to an 80% eccentric stenosis of the LMCA on angiography ( Fig 1AB ) due to compression on ostium and shaft by a severely dilated pulmonary trunk ( Fig 1C ). Right heart catheterization revealed pulmonary artery pressures (PAPs) of 90/40/68mmHg. Operative risk for CABG was deemed prohibitive, thus the patient underwent high-risk PCI of the LMCA under IV conscious sedation. Initial angiography confirmed a patent LMCA with minimal longitudinal compression. Opening PAPs (102/37/64mmHg) with supplemental oxygen (FiO 2 /PaO 2 0.76/168mmHg) were similar to preop findings ( Fig 1D ). To replicate her symptomatology, supplemental oxygen was discontinued, resulting in rapid worsening of LMCA compression with severe reduction in LMCA cross-sectional area at room air conditions (FiO 2 /PaO 2 0.21/70mmHg), with corresponding suprasystemic PAP (122/44/73mmHg) ( Fig 1E) . Under IVUS guidance, a preselected stent was deployed producing complete LMCA patency without evidence of dynamic compression; minimal stent areas were unchanged at supraphysiologic and physiologic conditions: 19 vs 20mm 2 , FiO 2 0.73 vs 0.21 ( Fig 1F ). Discussion: LMCA stenosis from extrinsic compression of the vessel by an enlarged pulmonary artery is a rare etiology of acute coronary syndromes. Treatment options include PCI, CABG, reimplantation, or PA reduction plasty. While preop imaging clearly demonstrated LMCA compression by a dilated PA, during PCI true and dynamic severity of LMCA compression was revealed only under “normoxic conditions” (FiO 2 0.21). This paroxysmal “nut-cracker” phenomenon from inadvertent reversal of dynamic LMCA compression highlights the importance of normoxia in making the diagnosis of such anomalies in susceptible individuals with pHTN.

Abstract 16402: Pitx2c-Conditional Knockout Mice May Become a Useful Model to Elucidate the Pathogenesis of Post-Capillary Pulmonary Hypertension

Introduction: Pulmonary hypertension (PH) is an intractable disease that causes cardiopulmonary dysfunction due to elevated pulmonary arterial pressure. The pathogenesis of PH varies greatly depending on whether the primary lesion is upstream or downstream of the pulmonary capillaries, and the latter, post-capillary PH (pc-PH) caused by pulmonary vein stenosis/obstruction or left heart disease, currently has not an appropriate animal models to study its pathophysiology and pharmacological effects. Hypothesis: We hypothesized that a tissue-specific deletion of a gene involved in the formation of pulmonary veins could create a pathological mouse model of pc-PH. Methods: Focusing on the homeobox transcription factor Pitx2c, which has been reported to be indispensable for the formation of pulmonary veins, we generated Pitx2c-conditional knockout (cKO) mice specific for pulmonary vein and atrial myocardium by crossing Pitx2c-floxed mouse lines with Cre mouse lines for sarcolipin, a sarcoplasmic reticulum membrane protein. Then, we examined the cardiac morphology and hemodynamics of the Pitx2c-cKO mice. Results: Tissue weights of 8-week-old Pitx2c-cKO mice showed that the relative weights of both atria (especially the right atrium), right ventricle and lungs were significantly increased in Pitx2c-cKO mice, while the relative weight of the left ventricle was decreased. Furthermore, echocardiography performed on 3-month-old Pitx2c-cKO mice revealed that the right ventricle was markedly enlarged in Pitx2c-cKO mice, with enlarged pulmonary artery annulus diameter and increased velocity time integral (VTI) of blood flow through the right ventricular outflow tract. Pitx2c-cKO mice also had significantly decreased left ventricular end-diastolic diameter (LVDd), end-systolic diameter (LVDs), and mass (LVM). On the other hand, there was no difference in left ventricular fractional shortening (%FS) or tricuspid annular plane systolic excursion (TAPSE), indicating no cardiac dysfunction in Pitx2c-cKO mice. Cardiac catheterization also revealed elevated right ventricular pressure in some Pitx2c-cKO mice. Conclusion: These primary findings suggest that the Pitx2c-cKO mice may be a model for understanding the pathogenesis of pc-PH.

Abstract 285: Intraventricular And Subarachnoid Hemorrhage Secondary To Arteriovenous Malformation, A Diagnostic Neurologic Manifestation Of Osler‐Weber‐Rendu Disease

Introduction Osler‐Weber‐Rendu disease, also known as hereditary hemorrhagic telangiectasia (HTT), is a developmental vascular disease characterized by multiple arteriovenous malformations (AVMs) due to genetic defects in endothelial angiogenesis pathways. HHT is a clinical diagnosis based on the fulfillment of the Curacao Diagnostic Criteria, including involvement of internal organs with AVMs, significant recurrent nosebleeds, telangiectasias, and family history of HHT. HHT has a prevalence of 1.5 to 2 people/10,000, although this is considered a falsely low representation due to missed diagnosis and variable penetrance. Autosomal dominantly inherited heterozygous mutations disrupt the TGF‐beta‐mediated pathways causing aberrant blood vessel development with fragility and AVM formation. There are two forms of HHT: (HHT1) has a higher incidence in women and typically involves pulmonary and cerebral arteriovenous malformations (AVM). Mutations in the endoglin gene are thought to be responsible for HTT1 and comprise approximately 61% of the cases. HTT2 is associated with a higher rate of liver AVMs, involves a mutation in Activin A Receptor‐Like Type 1 (ACVRL1), and is responsible for approximately 37% of cases. Other genetic mutations include SMAD4 and GDF2, which are transmitter and binding proteins and occur about 2% of the time. Methods Case report and review of literature Results Case:A 52‐year‐old woman with a large frontoparietal arteriovenous malformation originally found at the age of 17, with a history of frequent epistaxis, mucocutaneous telangiectasias and two children with epistaxis and telangiectasias. Her diagnosis of HHT was made at her third hjospitalization due to a non‐traumatic subarachnoid hemorrhage. A Chest CT angiography and a CT angiography of the intra and extracranial vasculature demonstrated an extensive right holohemispheric cerebral AVM, an unruptured 8‐mm basilar artery aneurysm, and multiple enlarged pulmonary arteries with narrow inlet and outlets concerning for pulmonary AVMs. A subsequent digital subtraction angiogram (DSA) of the brain confirmed the extensive holohemispheric AVM, unruptured basilar artery aneurism with subarachnoid hemorrhage originating from the AVM. On examination she had multiple lingual, and hard/soft palate telangiectasias and an extensive anterior pedal telangiectasia. Given the heavy cerebral AVM burden with multiple cerebral artery feeders, the AVM angiosclerosis and basilar artery aneurysm embolization were deferred. The patient proceeded under medical management alone with a plan for personal and familial genetic testing. Conclusion HHT is a rare cause of cerebral AVMs at high risk of spontaneous bleeding. Managing these AVMs can be a challenge, given the extent and location of these. However, diagnosis of HHT can inform prognosis and guide medical management due to improved prognosis for HHT‐related AVMs and aneurysms compared to non‐HHT AVMs.

Echocardiographic reference intervals of the dimensions of the main pulmonary artery and the right pulmonary artery: a prospective study in 269 healthy dogs

IntroductionNo data are available on the echocardiographic reference intervals (RIs) for the main pulmonary artery (MPA) and right pulmonary artery (RPA) dimensions in a large sample of dogs. Therefore, we aimed to describe the echocardiographic RIs of the MPA and RPA dimensions in normal dogs. Animals, materials, and methodsTwo hundred and sixty nine healthy dogs of different breeds, age and body weight (BW) were prospectively enrolled in this multicenter, observational study. The MPA diameter, RPA maximum diameter (RPAmax), and RPA minimum diameter (RPAmin) were measured from the right parasternal short axis view. Prediction intervals (PIs) for MPA, RPAmax and RPAmin were generated using allometric scales. Reference intervals (RI) of MPA indexed to the ascending aorta (MPA/AO), and RPAmax and RPAmin indexed to the aortic annulus (RPAmax/Aod and RPAmin/Aod), were defined. ResultsA positive linear relationship between MPA, RPAmax, RPAmin and BW was evident after logarithmic transformation (R2 = 0.859, R2 = 0.787 and R2 = 0.725, respectively; P<0.0001). According to allometric scales, the PI for the MPA normalized for BW (MPA_N) was between 5.50 and 8.07, the PI for the RPAmax normalized for BW (RPAmax_N) was between 3.23 and 5.62, while the PI for the RPAmin normalized for BW (RPAmin_N) was between 1.62 and 3.30. The median MPA/AO was 0.92 (RI, 0.78–1.01), the median RPAmax/Aod was 0.70 (RI, 0.53–0.98) and the median RPAmin/Aod was 0.40 (RI, 0.29–0.61). Discussion and conclusionsThe reported RIs of the MPA and RPA dimensions in normal dogs could increase the diagnostic accuracy of transthoracic echocardiography in the identification of pulmonary artery enlargement in dogs.

Echocardiographic characteristics of dogs with pulmonary hypertension secondary to respiratory diseases.

Pulmonary hypertension (PH) secondary to respiratory disease is caused by pulmonary vascular remodeling and hypoxia. Severe PH can induce various clinical signs, including syncope and right-sided heart failure. To investigate the echocardiographic characteristics in dogs with PH secondary to respiratory diseases. Thirty-one dogs with respiratory diseases with or without PH and 15 healthy dogs. Prospective cross-sectional study. Dogs were classified according to respiratory disease (obstructive airway/lung disease [OALD] or restrictive lung disease [RLD]) and PH-relevant signs. The association between echocardiographic variables and PH (classified by respiratory disease and PH-relevant signs) was investigated. Twenty-one dogs were diagnosed with PH; of these, 11 showed PH-related signs (OALD, n = 2; RLD, n = 9), 14 had right ventricular hypertrophy, and 19 had pulmonary arterial enlargement. Right ventricular dysfunction and dilatation were observed only in dogs with PH-related signs (n = 10). Left and right ventricular stroke volumes were significantly lower in dogs with PH (median [interquartile range]: 17.2 [12.4-20.8] and 16.8 [15.3-29.5] mL/m2 , respectively). Dogs with RLD had higher echocardiography-estimated pulmonary vascular resistance than those with OALD (median [interquartile range]: 3.1 [1.9-3.3] and 1.6 [1.3-2.2], respectively). Pulmonary arterial enlargement was the most common echocardiographic finding in dogs with PH secondary to respiratory diseases. Right ventricular dysfunction, dilatation, and decreased left and right ventricular stroke volume were significantly associated with the PH-related signs, indicating that comprehensive echocardiography is recommended in dogs with respiratory disease. Restricted lung disease might induce more severe PH than OALD.

Low-Dose Computed Tomography Scan Features Are Associated With Annual Risk of Hospitalization

BackgroundThe objective of this study was to investigate whether lung cancer screening low-dose computed tomography (LDCT) can be used to identify features associated with increased risk of hospitalization during the subsequent year. MethodsPatients who underwent lung cancer screening between 2015 and 2020 with at least 1-year follow-up were identified. Patient charts were examined and LDCT scans were analyzed using body segmentation software to identify characteristics potentially associated with frailty and injury. Hospitalization was defined as an admission >48 hours within 1 year of the LDCT scan; admissions for elective procedures were excluded. ResultsThere were 1606 LDCT scans that met inclusion criteria. The cohort median age was 65 years (interquartile range, 61-70 years), with 54% (875/1606) female, 50% (804/1606) current smokers, and median smoking history of 40 pack-years (interquartile range, 34-50 pack-years). There were 107 hospitalizations within 1 year of the LDCT scan. On univariate analysis, cardiomegaly (odds ratio [OR], 2.83; 95% CI, 1.33-6.04; P < .01), emphysema (OR, 1.67; 95% CI, 1.09-2.56; P = .02), pulmonary artery enlargement (OR, 2.72; 95% CI, 1.09-6.62; P = .03), and coronary artery calcification (OR, 1.59; 95% CI, 1.07-2.41; P = .02) were associated with increased risk of hospitalization. On multivariate analysis, after controlling for age and sex, cardiomegaly (OR, 2.41; 95% CI, 1.05-4.97; P = .03), emphysema (OR, 1.88; 95% CI, 1.19-2.93; P < .01), and body mass index >30 kg/m2 (OR, 1.55; 95% CI, 1.02-2.36; P = .04) were associated with increased risk of hospitalization. ConclusionsIn lung cancer screening patients, features extractable from LDCT scans are associated with increased risk of hospitalizations during the subsequent year.

Quadricuspid Pulmonary Valve with Pulmonary Artery Aneurysm.

HomeRadiologyRecently Published PreviousNext Reviews and CommentaryFree AccessImages in RadiologyQuadricuspid Pulmonary Valve with Pulmonary Artery AneurysmAyşe Füsun Bekirçavuşoğlu , Süleyman BekirçavuşoğluAyşe Füsun Bekirçavuşoğlu , Süleyman BekirçavuşoğluAuthor AffiliationsFrom the Bursa City Hospital, Doğanköy mah, 16110 Nilüfer, Bursa, Turkey.Address correspondence to A.F.B. (email: [email protected]).Ayşe Füsun Bekirçavuşoğlu Süleyman BekirçavuşoğluPublished Online:May 16 2023MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 70-year-old female patient had repeatedly sought medical attention, and a subsequent chest radiograph showed enlargement in the pulmonary artery. Coronary CT angiography (CCTA) was performed, showing a quadricuspid pulmonary valve and aneurysmal enlargement of the pulmonary artery (diameter of 57 mm) (Figure). This was conservatively managed, and the patient is doing well.Images in a 70-year-old woman with multiple symptoms. (A) Chest radiograph shows an enlarged pulmonary artery (arrows). (B) Multiplanar reformatted coronary CT angiography (CCTA) scan shows a quadricuspid pulmonary valve (leaflets are numbered as 1, 2, 3, 4 [arrow]), with one smaller cusp (leaflet number 4). (C) Volume-rendered CCTA scan demonstrates aneurysmal dilatation of the pulmonary trunk and its main branches. Ao = aorta, LA = left atrium.Download as PowerPointOpen in Image Viewer The quadricuspid pulmonary valve is a rare congenital anomaly with a prevalence reported from one in 400 to one in 1000 in postmortem specimens (1). Although usually isolated, it may be associated with patent ductus arteriosus, atrial or ventricular septal defects, and aortic valve anomalies (2,3). Aneurysms of the pulmonary arteries are also rare, with a prevalence of 1:14000 in autopsy series (4). There are a limited number of cases associated with quadricuspid pulmonary valve (3–5). CCTA is a useful tool in the evaluation of rare anomalies that are difficult to evaluate with echocardiography.Disclosures of conflicts of interest: A.F.B. No relevant relationships. S.B. No relevant relationships.Data sharing: No data were generated or analyzed during the study.

Unrecognized Patent Foramen Ovale in Patient With Sinus Venosus-Type Atrial Septal Defect With Partial Anomalous Pulmonary Venous Return.

Unrecognized Patent Foramen Ovale in Patient With Sinus Venosus-Type Atrial Septal Defect With Partial Anomalous Pulmonary Venous Return.

The association between pulmonary artery enlargement and mortality in an Emergency Department population undergoing computed tomography pulmonary angiography.

Findings of an enlarged pulmonary artery diameter (PAd) and increased pulmonary artery to ascending aorta ratio (PA:AA) on contrast-enhanced computed tomography pulmonary angiography (CTPA) are associated with increased mortality in particular groups of patients with cardiopulmonary disease. However, the frequency and prognostic significance of these incidental findings has not been studied in unselected patients evaluated in the Emergency Department (ED). This study aims to determine the prevalence and associated prognosis of enlarged pulmonary artery measurements in an ED cohort. We measured PA and AA diameters on 990 CTPA studies performed in the ED. An enlarged PA diameter was defined as >27 mm in females and >29 mm in males, while an increased PA:AA was defined as >0.9. Poisson regression was performed to calculate prevalence ratios for relevant comorbidities, and multivariable Cox regression was performed to calculate hazard ratios (HR) for mortality of patients with enlarged pulmonary artery measurements. An enlarged PAd was observed in 27.9% of 990 patients and was more commonly observed in older patients and in patients with obesity or heart failure. Conversely, PA:AA was increased in 34.2% of subjects, and was more common in younger patients and those with peripheral vascular disease or obesity. After controlling for age, sex, and comorbidities, both enlarged PAd (HR 1.29, 95% CI 1.00-1.68, p = 0.05) and PA:AA (HR 1.70, 95% CI 1.31-2.22 p < 0.01) were independently associated with mortality. In sum, enlarged PAd and increased PA:AA are common in patients undergoing CTPAs in the ED setting and both are independently associated with mortality.

Hoarseness as a Predictor for Pulmonary Arterial Aneurysm and Extrinsic Left Main Coronary Artery Compression in Patients with Severe Pulmonary Hypertension.

Pulmonary artery (PA) enlargement is a common finding in patients with severe pulmonary hypertension (PH) and may be associated with extrinsic compression of the left main coronary artery (LMCA-Co) and/or compression of the left recurrent laryngeal nerve resulting in hoarseness named as Ortner syndrome (OS). In this study, we evaluated the diagnostic impact of OS in predicting the PA aneurysm and significant LMCA-Co in patients with PH. Our study population comprised retrospectively evaluated 865 with PH confirmed with the right heart catheterization between 2006 and 2022. Patients underwent coronary angiography due to several indications, including the presence of a PA aneurysm on echocardiography, angina symptoms, or the incidental discovery of LMCA-Co on multidetector computed tomography. The LMCA-Co is defined as diameter stenosis ³ 50% in reference distal LMCA segment on two consecutive angiographic planes. The LMCA-Co and hoarseness were documented in 3.8% and 4.3% of patients with PH, respectively. Increasing PA diameter was significantly associated with worse clinical, hemodynamic, laboratory, and echocardiographic parameters. The receiver operating curves revealed that the PA diameter >41 mm was cutoff for hoarseness (AUC: 0.834; sensitivity 69%, specificity 84%, and negative predictive value 98%), and PA diameter >35 mm was cutoff for LMCA-Co >50% (AUC: 0.794; sensitivity 89%, specificity 58 %, and negative predictive value 99%). An odds ratio of hoarseness for LMCA-Co was 83.3 (95% confidence interval; 36.5-190, P < 0.001) with 3.2% sensitivity, 98.7% specificity, and 59% positive and 98% negative predictive values. In this study, a close relationship was found between the presence of hoarseness and the probability of extrinsic LMCA-Co by enlarged PA in patients with severe PH. Therefore, the risk of LMCA-Co should be taken into account in patients with PH suffering from hoarseness.

Vicarious excretion of contrast medium to small intestine in a dog with Toxocara canis infection

A male mixed-breed dog of unknown age was presented with a history of bloody diarrhea and cachexia. Toxocara canis in vomitus was identified by a parasitologist. Hematology revealed low hematocrit, eosinophilia, and low albumin. Computed tomography (CT) revealed an enlarged pulmonary artery with an irregular wall, micronodules in the lung, and vicarious excretion of contrast medium to small intestine. CT scan was helpful for identifying lung lesions and the central organs of larval migration and also show vicarious excretion of contrast medium to the small intestine in T. canis infection.

Discussion

Discussion

972 PULMONARY HYPERTENSION AND EMBRYOLOGICAL REMNANT: WHAT DO THEY HAVE TO DO WITH EACH OTHER? A CASE REPORT

Abstract Background Pulmonary hypertension (PH) is defined as a resting mean pulmonary artery pressure of 20 mmHg or above. The importance of identifying the underlying causes of PH is well known for a correct management and treatment. In particular, any cardiac causes, included shunt, must be investigated. Case Summary A 73-year-old woman presented to the emergency room for asthenia and dyspnea. First line exams as ECG and X-ray were executed resulting normal. Laboratory assessment showed an elevated brain natriuretic peptide at 675 pg/ml and a D-dimer value of 1116 ng/mlFEU (n.v. &amp;lt; 500 ng/mlFEU) so with the suspect of pulmonary thromboembolism a CT-scan with contrast was performed. It was negative for acute thromboembolism, but it revealed an enlarged pulmonary artery (with a diameter of 39 mm), a possible defect of interatrial septum and an anomalous drainage of inferior vena cava (IVC) into the left atrium (LA). A transthoracic echocardiogram confirmed the anomalous drainage of IVC into the LA that appears dilated but was not diagnostic for the interatrial defect. Furthermore, PH was suspected (systolic peak tricuspid regurgitation velocity of 3,5 m/s, RA area of 24 cm2, tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure of 0.26 mm/mmHg). A 6-minute walking distance was 376 m. The patient completed the exams with a transesophageal echocardiography that revealed an inferior-type caval vein defect and an over-developed Eustachian valve which divides the right atrium (RA) and connect the IVC with the LA directing the blood flow towards it through the inter-atrial septal defect. Discussion The Eustachian valve is an embryologic remnant at the junction of the IVC and RA. While it typically does not have any pathologic significance, veno-arterial shunting can rarely occur in patients with prominent eustachian valves and atrial septal defects.

AVOIDING THYROID TESTING FATIGUE: PULMONARY ARTERIAL HYPERTENSION (PAH) IN A PATIENT WITH HASHIMOTO DISEASE

AVOIDING THYROID TESTING FATIGUE: PULMONARY ARTERIAL HYPERTENSION (PAH) IN A PATIENT WITH HASHIMOTO DISEASE