Massive Pulmonary Artery Research Articles

Long-Term Survival in Idiopathic Pulmonary Arterial Hypertension Associated with Massive Pulmonary Artery Dilation

The present report describes two patients with long-term survival after being diagnosed with idiopathic pulmonary arterial hypertension more than 20 years earlier. Both patients were treated with calcium channel blockers for several years and are currently maintained on bosentan, an oral endothelin receptor antagonist. Severe dilation of the main pulmonary arteries is present in both patients and may be related to long-term survival with idiopathic pulmonary arterial hypertension.

Lifesaving Kissing Stent for Pulmonary Trunk Stenosis Due to Primary Angiosarcoma

A 62-year-old diabetic female was referred to our institution with a 6-month history of pulmonary hypertension and worsening right-sided heart failure. Computed tomography of the chest and pulmonary angiogram revealed a pulmonary artery mass. Due to patient's frail state, palliative kissing stenting to both pulmonary arteries was performed with optimal angiographic results and overt clinical improvement. At 5 month follow-up, both stents were patent and adequate lung perfusion was observed bilaterally.

Open Embolectomy of an Acute Pulmonary Artery Embolism after Pulmonary Lobectomy

Acute massive pulmonary artery embolism after pulmonary resection is very rare, but has a high mortality rate. This is one of the most severe complications after pulmonary resection. Acute pulmonary artery embolism developed suddenly in a patient who underwent lobectomy and was recovering without complications. Because the patient’s condition was aggravated after conservative treatment, we did emergency open embolectomy which was successful. Hence, we report this case with a literature review.

Thrombelastometry-guided thrombolytic therapy in massive pulmonary artery embolism

We report a case of a patient who suffered a massive pulmonary embolism with cardiac arrest on post-operative day 4 after a Whipple operation. Despite thrombolytic therapy with the recommended maximal bolus of 50 mg recombinant tissue type plasminogen activator (rt-PA), thrombelastometry showed no signs of fibrinolysis and cardiogenic shock persisted, after only a transient hemodynamic improvement. Not until a repeat bolus of 25 mg rt-PA and an infusion of 50 mg/h did thrombelastometry demonstrate complete fibrinolysis. Although only residual emboli were seen on computed tomography, the patient died secondary to refractory right heart failure. This demonstrates that the standard dosing of thrombolytics may fail in a subgroup of patients, and suggests that thrombelastometry may be useful for early dose adjustment when standard dosing regimens fail.

Massive Left Pulmonary Artery Pseudoaneurysm in a Young Child

Pulmonary artery (PA) pseudoaneurysm is a rare but life-threatening disorder. We describe an unusually large PA pseudoaneurysm in a young child that posed diagnostic and therapeutic challenges. An 18-month-old male child, weighing 7 kg, had presented with recurrent hemoptysis. Chest X-ray showed

Efficacy and Safety of Low Dose Recombinant Tissue-Type Plasminogen Activator for the Treatment of Acute Pulmonary Thromboembolism: A Randomized, Multicenter, Controlled Trial

BackgroundOptimal dosing of the recombinant tissue-type plasminogen activator (rt-PA) is important in treating pulmonary thromboembolism (PTE). The aim of this study was to compare the efficacy and safety of a 50 mg/2 h rt-PA regimen with a 100 mg/2 h rt-PA regimen in patients with acute PTE.MethodsA prospective, randomized, multicenter trial was conducted in which 118 patients with acute PTE and either hemodynamic instability or massive pulmonary artery obstruction were randomly assigned to receive a treatment regiment of either rt-PA at 50 mg/2 h (n = 65) or 100 mg/2 h (n = 53). The efficacy was determined by observing the improvements of right ventricular dysfunctions (RVDs) on echocardiograms, lung perfusion defects on ventilation perfusion lung scans, and pulmonary artery obstructions on CT angiograms. The adverse events, including death, bleeding, and PTE recurrence, were also evaluated.ResultsProgressive improvements in RVDs, lung perfusion defects, and pulmonary artery obstructions were found to be similarly significant in both treatment groups. This is true for patients with either hemodynamic instability or massive pulmonary artery obstruction. Three (6%) patients in the rt-PA 100 mg/2 h group and one (2%) in the rt-PA 50 mg/2 h group died as the result of either PTE or bleeding. Importantly, the 50 mg/2 h rt-PA regimen resulted in less bleeding tendency than the 100 mg/2 h regimen (3% vs 10%), especially in patients with a body weight < 65 kg (14.8% vs 41.2%, P = .049). No fatal recurrent PTE was found in either group.ConclusionsCompared with the 100 mg/2 h regimen, the 50 mg/2 h rt-PA regimen exhibits similar efficacy and perhaps better safety in patients with acute PTE. These findings support the notion that optimizing rt-PA dosing is worthwhile when treating patients with PTE.Trial registrationclinicaltrials.gov; Identifier: NCT00781378

Comparing different thrombolytic dosing regimens for treatment of acute pulmonary embolism

Background Optimal dosing of recombinant tissue-type plasminogen activator (rt-PA) is important in treating pulmonary thromboembolism (PTE). Methods Objective The aim of this study was to compare the efficacy and safety of a 50 mg/2 h rt-PA regimen with a 100 mg/2 h rt-PA regimen in patients with acute PTE. Design A prospective, randomized, open label trial. Setting A multicenter trial in China. Subjects 118 patients with acute PTE and either hemodynamic instability or massive pulmonary artery obstruction. Intervention Patients were randomly assigned to receive a treatment regimen of either rt-PA at 50 mg/2 h (n = 65) or 100 mg/2 h (n = 53). Outcomes The efficacy was determined by observing the improvements of right ventricular dysfunctions (RVDs) on echocardiograms, lung perfusion defects on ventilation perfusion lung scans, and pulmonary artery obstructions on CT angiograms. The adverse events, including death, bleeding, and PTE recurrence, was also evaluated. Results Progressive improvements in RVDs, lung perfusion defects, and pulmonary artery obstructions were found to be similar in both treatment groups. This is true for patients with either hemodynamic instability or massive pulmonary artery obstruction. Three (6%) patients in the rt-PA 100 mg/2 h group and one (2%) in the rt-PA 50 mg/2 h group died as the result of either PTE or bleeding. Importantly, the 50 mg/2 h rt-PA regimen resulted in less bleeding tendency than the 100 mg/2 h regimen (3% vs. 10%), especially in patients with a body weight, 65 kg (14.8% vs. 41.2%, P = 0.049). No fatal recurrent PTE was found in either group. Conclusions Compared with the 100 mg/2 h regimen, the 50 mg/2 h rt-PA regimen exhibits similar efficacy and perhaps better safety in patients with acute PTE. These findings support the notion that optimizing rt-PA dosing is worthwhile when treating patients with PTE.

Rosai-Dorfman Disease Presenting as a Pulmonary Artery Mass

Rosai-Dorfman disease is rare and typically presents with cervical lymphadenopathy, but may manifest as extranodal disease. This disease is generally indolent and self-limited, but it carries a poor or fatal prognosis when it is advanced or when it involves and compresses vital structures. We present a case of Rosai-Dorfman disease affecting the pulmonary arteries in a 22-year-old woman with severe, symptomatic right heart failure.

MRI of Intimal Sarcoma of the Pulmonary Arteries

A 38-year-old woman presented with left lower chest pain. At the age of 3 years, a commissurotomy of the pulmonary valve and infundibulectomy was performed to correct severe infundibular pulmonary stenosis. The initial thoracic CT diagnosed bilateral pulmonary embolism. Echocardiography revealed a filiforme mass in the pulmonary artery 33 mm in length, floating in the right outflow tract, suggesting a pulmonary sarcoma. In addition, a moderate pulmonary valve insufficiency with mild stenosis was diagnosed. Cardiac magnetic resonance (CMR) confirmed the mass in the left pulmonary artery (PA) with floating parts and a small mass in the right PA (Figure 1) and provided complementary findings identifying …

A huge aortic arch aneurysm mimicking massive pulmonary artery embolism

A huge aortic arch aneurysm mimicking massive pulmonary artery embolism

Obstructive mass in pulmonary artery

Obstructive mass in pulmonary artery

Thrombosis of the Pulmonary Artery in a Yearling Thoroughbred Colt

Thrombosis of the Pulmonary Artery in a Yearling Thoroughbred Colt

A Benign Pulmonary Artery Mass

We present a case of a benign pulmonary artery mass leading to pulmonary artery stenosis. A 39-year-old male patient had a dyspnea on exertion and chest discomfort four months before admission. Computerized tomographic scan revealed a mass extending 2.1 cm in the right pulmonary artery resulting in pulmonary artery stenosis. He underwent a mass resection and pulmonary artery reconstruction under cardiopulmonary bypass. His symptoms improved postoperatively. Histology revealed it was a reactive lymph node. It is recommended that surgical resection should be the only alternative for complete relief of the symptoms in such patients.

Small cell neuroendocrine carcinoma presenting as a pulmonary artery mass

Small cell neuroendocrine carcinoma presenting as a pulmonary artery mass

Relation of Ultrasound Morphologic Characteristics of Central Pulmonary Artery Thromboemboli to Their Ex Vivo Lysibility

Ultrasound morphology of massive central pulmonary artery thromboemboli (TE) is an independent predictor of 30-day mortality. The aim of this study was to asses ex vivo lysibility of morphologically different TE. Forty-five central pulmonary artery TE, collected at autopsies, were divided into hypoechoic (group A) and hyperechoic (group B) categories. TE were lysed with alteplase in a perfusing system simulating pulmonary circulation for 1 hour. The grey scale mean of thrombi in group B was higher compared with group A (64 +/- 7 vs. 38 +/- 7, respectively, P < .01). Spontaneous lysis in group A did not differ compared with group B (2.2% +/- 0.5% vs. 2.1% +/- 0.4%, P = .4). After incubation with alteplase, the weight of TE was reduced more in group A than in group B (16% +/- 2% vs. 11% +/- 2%, P < .001). The grey scale mean negatively correlated with the percentage of TE weight reduction (0.768) (P < .001). Ultrasound morphology of TE from central pulmonary arteries correlates significantly with ex vivo lysibility. Hypoechoic TE are more susceptible to thrombolysis than hyperechoic TE.

AN UNUSUAL PRIMARY PRESENTATION OF NEPHROTIC SYNDROME AS RENAL VEIN THROMBOSIS: A HUNT FOR THE HIDDEN CAUSE!

Background Bilateral renal vein thrombosis (RVT) could be due to many different etiologies with varying primary presentations. RVT is often difficult to diagnose early on in the disease process as the patients are often asymptomatic and renal insufficiency is mild or absent. In adults, primary RVT is most commonly due to nephrotic syndrome typically of membranous type. In fact, 40% of RVT in adults is attributed to nephrotic syndrome. Case Report We present a case of a 40-year-old man who presented with gradually progressing left-sided pleuritic chest pain, shortness of breath, and nonproductive dry cough for 2 months that worsened over the past 2 weeks. Initial chest radiography was reported as normal. A chest CT scan with contrast was obtained that revealed massive bilateral pulmonary artery embolism with lung tissue infarction. Upon further biochemical tests and appropriate radiologic investigations, it was revealed that the source of his pulmonary embolism was, in fact, thrombosis of both his renal veins. This was correlated with the laboratory tests that demonstrated massive proteinuria (11 g/d) and hypoalbuminemia (1.2 g/dL) and hypercholesterolemia, which uncovered the diagnosis of nephrotic syndrome. Discussion Nephrotic syndrome can complicate any disease that disturbs the negative electrostatic charge of GBM and the podocytes and their slit diaphragms. Nephrotic syndrome is a clinical complex characterized by several renal and extrarenal manifestations, such as proteinuria (3.5 g/1.73 m2/24 h), hypoalbuminemia, edema, hyperlipidemia, lipiduria, hypercoaguability, peritonitis, congestive heart failure, and generalized prothrombotic changes resulting in pulmonary embolism, RVT, and stroke. Spontaneous peripheral and arterial thrombosis, RVT, and pulmonary embolism can develop due to hypercoagulability during nephrotic syndrome. The cause of hypercoagulability is multifactorial, including altered levels of proteins C and S, urinary loss of antithrombin III, hyperfibrinogemia due to increased hepatic synthesis, impaired fibrinolysis, and increased platelet aggregability. Platelet activation and aggregation is further stimulated by high plasma concentrations of cholesterol, fibrinogen, and VWF. Learning Point The purpose of this abstract is to present an unusual cause of PE in a young patient. An astute clinical suspicion led to an early diagnosis of the RVT in this patient and hence initiation of early treatment and full recovery within few months.

A cryptogenic pulmonary embolism: Left atrial myxoma occluding an atrial septal defect

Acute pulmonary embolism represents a severe condition associated with significant morbidity and mortality. The main source of pulmonary embolism is represented by deep venous thrombosis. Less frequent causes are right-sided heart chamber clots, neoplastic emboli into the systemic veins, or the association of left atrial (LA) thrombi and atrial septal defects (ASDs). We describe a unique case of acute pulmonary embolism related to the contemporary presence of LA myxoma and ASD, with the mass behaving as an ASD occluder.

Transesophageal Echocardiographic Detection of Papillary Fibroelastoma in the Pulmonary Artery

A 57-yr-old man presented for excision of a pulmonary artery (PA) mass after a 5-mo history of productive cough and wheezing. Computerized tomography scan revealed a large, stable, eccentric, filling defect within the main and left PA. Positron emission tomography demonstrated a single, intensely hypermetabolic focus in the PA region. Preoperative transthoracic echocardiography showed no abnormalities. After the induction of anesthesia, transesophageal echocardiography (TEE) examination was performed, revealing normal left ventricular systolic function and mild enlargement of the right ventricle. The main PA was dilated, with a mass extending from the main PA into the left main PA (Fig. 1). Close inspection of the pulmonary valve (PV) revealed a previously undetected small mobile lesion, independent of the PA mass, and not associated with PV restriction (Fig. 2 and video loop (available at www.anesthesia-analgesia.org). After cardiopulmonary bypass, a longitudinal incision along the PA exposed both the PA mass and the PV lesion. The PA mass nearly occluded the main PA and extended into the left main PA. Partial resection of the mass was performed, and a freestyle graft was used to repair the PA. Pathology examination indicated a spindle cell sarcoma. The PV lesion was excised and the valve repaired; microscopic examination identified a papillary fibroelastoma. Intensive care and hospital stay were uncomplicated.Figure 1.: Upper esophageal short axis view demonstrating the tumor (T) in the main pulmonary artery (PA). Right ventricle (RV) and aortic valve (AV) are also seen in this view.Figure 2.: Upper esophageal short axis view demonstrating the pulmonary valve fibroelastoma (PVFE). Right atrium (RA) and left atrium (LA), right ventricle (RV), and aortic valve (AV) are also seen in this view.In this case, the finding of the fibroelastoma of the PV during TEE examination was unexpected based on preoperative diagnostic evaluation, including transthoracic echocardiography. Before the advent of TEE, these rare, benign cardiac tumors were largely found incidentally during cardiac surgery or on necropsy. Transthoracic echocardiography is not usually effective for identification of such lesions (1). Fibroelastomas typically originate from valvular tissue, rather than myocardium. The differential diagnosis of a PV mass includes vegetation, thrombus, myxoma, and fibroelastoma. Definitive diagnosis is made only by histologic examination (2). Although fibroelastomas are typically benign, their presence increases the risk of embolic events, including myocardial infarction, pulmonary emboli, stroke, and even sudden death. The independent predictor of death or nonfatal embolization is tumor mobility (3). Treatment of choice is excision via surgical shaving and repair or replacement of the affected valve (3). In this case, the TEE allowed for the identification of the previously undiscovered fibroelastoma on the PV and assessment of the spindle cell sarcoma in the PA.

Off-Pump Open Pulmonary Embolectomy for Major Bilateral Pulmonary Emboli: Report of a Case

Acute massive or submassive pulmonary artery thromboembolism causes sudden hemodynamic deterioration, warranting immediate surgery. We report the case of a 67-year-old woman who suffered a syncopal attack resulting in shock, 3 weeks after undergoing orthopedic surgery. Preoperative radiologic imaging studies, including a lung perfusion scan, chest scan, and venography, showed a major bilateral pulmonary artery embolism (PE) originating from a leg vein. An inferior vena cava filter was inserted preoperatively during the venography. We performed an open pulmonary embolectomy without cardiopulmonary bypass by using a submammary trans-sternal bilateral thoracotomy approach. The patient recovered uneventfully and has been well for 13 months.

Large cell neuroendocrine carcinoma: an unusual presentation

Primary lung cancer presenting as a pulmonary artery mass is unusual. We describe such a presentation in a patient with a large cell neuroendocrine carcinoma of the lung, its evaluation, and its treatment.