Branch Of Right Pulmonary Artery Research Articles

Abstract 15837: Anomalous Bronchial Artery Origin- The Canary in the Coal Mine- For the Diagnosis of Chronic Thromboembolic Pulmonary Hypertension

Introduction- Anomalous bronchial artery origin is seen in 8.3% to 35% of cases with most originating from the aortic arch, internal mammary artery, and subclavian artery. Origin of this vessel from a coronary artery is extremely rare. Case presentation- A 49-year-old male with history of unprovoked pulmonary embolisms (PE) in the setting of triple antibody positive Antiphospholipid antibody syndrome on lifelong anticoagulation presented with left sided chest pain and dyspnea. Initial lab work showed a troponin of 5.46 ng/mL, BNP of 602 pg/mL and D-dimer of 0.62 ug/mL. EKG showed normal sinus rhythm with non-specific ST segment changes in anterior leads. Computed Tomography Angiography (CTA) was positive for a PE. There was concern for a false positive result due to previous history of multiple PEs while on therapeutic levels of warfarin and near normal D-dimer. Echocardiogram showed ejection fraction of 38% with akinesis of anteroapical and inferoapical segments and no evidence of shunt on bubble study. Cardiac catheterization showed non-obstructive coronaries. From the ostium of the right coronary artery there appeared a fistula like structure extending into the pulmonary vasculature. Pulmonary angiogram was performed and showed chronic occlusion in branches of right pulmonary artery (RPA), pulmonary hypertension (PH) with mean pulmonary artery pressure of 36 mmHg and no evidence of acute thrombus. There was aberrant origin of the right bronchial artery from the right coronary artery that was hypertrophied as it supplied collateral flow to the area of the occluded RPA. The patient was started on guideline directed medical therapy for heart failure and follow up was arranged for further outpatient management of PH. Discussion- A rare congenital anomaly was used to guide the diagnosis of a potentially devastating and treatable medical condition. It shows the limitations of a CTA in the setting of chronic PE.

Chylothorax, central venous thrombosis and pulmonary infarct in a patient of ovarian germ cell tumor: a case report

Background: Extra-abdominal presentations are rarely seen in ovarian germ cell tumors (OGCT). We report a case of a patient with OGCT who presented with systemic venous thrombosis, pulmonary infarct, and chylothorax simultaneously. Case Presentation: A 13-year-old girl presented with dyspnea, fever, and cough of 1 week duration. She was detected to have left-sided chylothorax. Carcinoma Antigen 125 and alpha fetoprotein levels were raised. Computed tomography showed a large ovarian mass, and thrombi in superior vena cava, left brachiocephalic vein, and segmental branch of right pulmonary artery. She also had a peripheral opacity in the right lung with a reverse-halo sign, suggestive of pulmonary infarct. She was diagnosed with yolk-sac tumor and managed with anticoagulation and subsequently neo-adjuvant chemotherapy and surgery. Conclusion: Prothrombotic state in OGCT can lead to systemic thrombosis which may result in chylothorax due to obstruction of thoracic duct. The phenomenon, though rare, should be kept in mind during management of OGCT.

Pulmonary Thromboembolism in COVID-19: Initial Experience from India

Pulmonary thromboembolic complications are increasingly being recognised in Coronavirus Disease 2019 (COVID-19) infections. Most of the cases of Pulmonary Embolism (PE) are often missed in presence of non-specific symptoms. The present report is about a 90-year-old COVID-19 positive male, asymptomatic on presentation, with no prior co-morbidities who developed acute onset shortness of breath along with elevated D-dimer levels four days post admission. Subsequently, a Computed Tomography Pulmonary Angiogram (CTPA) was done which revealed segmental and sub-segmental thromboembolism in upper and middle lobar branches of right pulmonary artery along with bilateral lower lobe ground-glass opacities consistent with COVID-19 pneumonia. As the patient was haemodynamically stable, he was managed conservatively on low molecular weight heparin and subsequently discharged on oral anti-coagulants. This report highlights the need for prompt evaluation of symptoms such as dyspnoea in COVID-19 patients and to rule out thromboembolic complications in them. In resource limited countries such as India with most of the COVID-19 centres having limited access to CT scans, triaging patients based on clinical suspicion and serially rising D-dimer levels may help identify those with thromboembolic complications.

Migration of Fragment of Inferior Vena Cava Filter to Pulmonary Artery

SESSION TITLE: Imaging SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Inferior Vena Cava (IVC) filters are recommended for prevention of pulmonary embolism in patients who have deep vein thrombosis (DVT) with contraindication to anticoagulation. IVC filters are either retrievable or non-retrievable. Retrievable filters are commonly used and they should be removed within 30 days of placement. Migration of fragments of IVC filter is a rare complication of this procedure (incidence <1%). In literature, fragments have been noted to migrate mainly to the right side of the heart or the pulmonary arteries. CASE PRESENTATION: A 72 y/o male with history of COPD came to emergency room for shortness of breath. Patient had an IVC filter placed two and a half years earlier after an episode of lower extremity DVT. He was a past smoker who quit many years back.Chest radiograph on admission showed findings suspicious for foreign body in a branch of right pulmonary artery. Computerized tomography of chest was done which revealed a thin linear metallic density in one of the sub-segmental branches of right lower lobe pulmonary artery, possibly a fractured piece of IVC filter. On retrospective review of chest radiographs, this metallic foreign body was visible after six months from the placement of the IVC filter. Patient did not recall having any other procedures or catheter placement except the IVC filter placement. Cardiothoracic surgery decision was not to intervene in this patient as this was an incidental finding without squeal. DISCUSSION: Management of an IVC filter fragment that migrates into pulmonary artery can be challenging. A variety of treatment options ranging from conservative management to endovascular or open surgical extraction of the migrated struts have been suggested. There are no clear guidelines nor sufficient literature on how to best manage and treat such complex situations. General consensus is to intervene in patients with complications like perforation of pulmonary artery. This case illustrates the importance of removal of IVC filters following the guideline and as soon as it is no longer needed. CONCLUSIONS: This case illustrates the need for clinicians to be aware to remove IVC filters when its no longer needed otherwise it could lead to disastrous complications. Reference #1: Tamer Hudali, Ali Zayed et al. A fractured inferior vena cava filter strut migrating to the left pulmonary artery. Respir Med Case Rep. 2015;16:3-6 Reference #2: Nicholas A. Rogers et al. Fracture and Embolization of an Inferior Vena Cava Filter Strut Leading to Cardiac Tamponade. Circulation. 2009;119:2535-2536. DISCLOSURE: The following authors have nothing to disclose: Praneet Iyer, Rabin Shrestha, Marwan Odeesh, Anurag Mehrotra, Muhammad Zaman No Product/Research Disclosure Information

Vascular anatomy in children with univentricular hearts regarding transcatheter bidirectional Glenn anastomosis

Transcatheter stent-secured Glenn anastomosis, aiming to reduce the invasiveness of palliation in patients with univentricular heart defects, has been reported in large experimental animals. The advent of biodegradable stents and tissue-engineered vascular grafts will make this procedure a reality in human patients. However, the relationship between the superior vena cava (SVC) and the right pulmonary artery (RPA) is different in humans. To characterise vascular anatomy in children with univentricular hearts, regarding technical aspects and device design for this procedure. Retrospective analysis of 35 thoracic computed tomography angiograms at a mean age of 18.1±22.4 months. Two types of arrangement between the SVC and the RPA were identified: anatomy convenient for immediate wire passage and stent deployment between the two vessels (60%); and pattern of early RPA branching, requiring the perforation wire to traverse the intervascular space to avoid entrance into the upper RPA branch (40%). In patients with the convenient vascular arrangement, the vessels were nearly perpendicular, having immediate contact, with the posterior SVC aspect partially "wrapping" the adjacent RPA in most patients. In patients with early RPA branching, the mean shortest SVC-to-central RPA distance was 4.3±2.7mm. For the total population, the mean length of proximal SVC that allowed stent deployment without covering the brachiocephalic vein was 15.6±5.1mm. A trumpet-shaped covered stent in a craniocaudal orientation reaching from the SVC into the prebranching RPA seems most suitable for achieving bidirectional Glenn anastomosis percutaneously in humans. However, the short length of the proximal SVC and the presence of early RPA branching pose challenges for optimal design of the dedicated device.

Abnormal branch of right pulmonary artery (A7): a case report and literature review.

In thoracic surgery, anatomic variations of pulmonary artery increase the risks for vessel injury and critical mistakes during pulmonary artery resection. We report a case of lung cancer with an extremely rare branch, a mediastinal A7 pulmonary artery. Some case reports of the mediastinal pulmonary artery exist until now. However, to the best of our knowledge, this is the first case of a medial basal segmental artery (from the following, it is referred to as A7) branching directly from main pulmonary artery in the literature. Therefore, there is no report that showed three-dimensional computed tomography (3D-CT) and operative findings. So, these information is very useful for thoracic surgeon. A 67-year-old man was admitted to our hospital in order to undergo operation for the treatment of lung cancer. We detected the anomalies preoperatively by 3D-CT. The 3D-CT shows the A7 pulmonary artery branches from the right main pulmonary artery directly. According to previous literature, the cases of a single branch from main pulmonary artery to lower lobe are only five cases. And, the only two of them are right side including our case. In spite of an extremely rare case, we were able to successfully perform a right middle lobectomy because the information obtained from the 3D-CT findings was sufficiently understood preoperatively.

Arteria praebronchialis found on MDCT: potentially dangerous aberrant artery supplying the left lower lobe.

To describe the incidence and CT features of a rare branching pattern of the pulmonary artery, the Arteria praebronchialis (AP): According to the initial description, the AP originates as the first branch of the left pulmonary artery, crosses the front of the left mainstem bronchus and then runs along the mediastinal margin as it gives off branches to one or more of the basal segments. Since the incidental discovery of the first patient, contrast-enhanced CT was screened by one radiologist for the presence of AP, until three more cases were identified. In those four patients, segmental and lobar branching patterns of the AP were assessed. The estimated incidence of the AP was 0.03%. All four patients were men. Compared to the normal interlobar artery, the AP was smaller (n = 2), larger (n = 1), or of an equal size (n = 1). The segmental branches of the AP to the upper lobe (present in three patients) were A3 and A4 (n = 1), A3 and A5 (n = 1) and A4+5 (n = 1), respectively. Regarding the supply of the left lower lobe, AP gave off A7+8 and A9 (n = 2), A7+8 (n = 1), and A7 and A10 (n = 1), respectively. In two patients, a contralateral variant of pulmonary arterial branching was found, with (right) A7 arising as the first branch of right pulmonary artery. The AP is extremely rare, but has a strong male predilection and highly diverse branching patterns in both the current study and the literature. Radiologists should familiarize themselves with the CT features of this surgically important variation, and be able to describe its lobar and segmental blood supply.

症例 左右冠動脈および右内胸動脈より肺動脈狭窄,閉塞部に特異な側副血行路を認めた大動脈炎症候群の1症例

症例 左右冠動脈および右内胸動脈より肺動脈狭窄,閉塞部に特異な側副血行路を認めた大動脈炎症候群の1症例

Echocardiographic Diagnosis and Transcatheter Occlusion of Pulmonary Arteriovenous Fistula in Cyanotic Newborn

Pulmonary arteriovenous malformation (PAVM) is a rare cause of cyanosis in newborn. A 12-day-old male newborn (2.8 kg) was referred to our hospital with the complaints of cyanosis and respiratory distress. On two-dimensional echocardiography, the right pulmonary artery (PA) appeared larger than left PA and the left atrium, left ventricle were dilated. The right heart chambers were in normal limits. A color flow Doppler echocardiogram revealed a turbulent flow due to a PAVM originating from medium branch of right PA, and continuous wave Doppler showed continuous flow pattern. Agitated saline injection resulted in the delayed appearance of the contrast in the left-side chambers three to four heart cycles after appearance in the right-side chambers; the study was considered positive and indicative of an intrapulmonary shunt. Selective angiography of the right PA confirmed the diagnosis of a large solitary PAVM in the right middle lobe with a feeding artery. Amplatzer vascular plug I, which is designed to close abnormal vascular structures, was chosen to close the PAVM. The deployment of device performed safely and the oxygen saturation of baby increased to 95% immediately after deployment. Heart failure and respiratory distress also resolved after the procedure.

Pulmonary embolism with acute pancreatitis: A case report and literature review

Acute pancreatitis is an inflammatory disease characterized by local tissue injury which can trigger a systemic inflammatory response. So vascular complications of pancreatitis are a major cause of morbidity and mortality. Pulmonary embolism in acute pancreatitis has been reported to be very rare. We reported a case of pulmonary embolism with acute pancreatitis. A 38-year-old woman broke out upper abdomen pain without definite inducement. She had no nausea and vomiting, fever, dyspnea, cough and expectoration, chest pain. The patient had been diagnosed with acute pancreatitis in local hospital. The patient was treated with antibiotics and proton pump inhibitors, and the abdomen pain was alleviated slightly. But the patient came forth cough and expectoration with a little blood, progressive dyspnea. A computed tomographic scan of the abdomen revealed pancreatitis. Subsequent computer tomography angiography of chest revealed pulmonary embolism (both down pulmonary arteries, left pulmonary artery and branch of right pulmonary artery). Dyspnea of the patient got well with thrombolytic treatment and anticoagulation therapy. Pulmonary embolism is a rare but potentially lethal complication of pancreatitis. Familiarity with this complication will aid in its early diagnosis, therapy and prevent pulmonary embolism, a rare but catastrophic phenomenon.

Detection of pulmonary vascular by transesophageal echocardiography during lung transplantation

Objective To detect the new views for pulmonary vascular by transesophageal echocardiography(TEE) during lung transplantation.Methods Seventeen cases with respiratory failure underwent lung transplantation.A series of scans were detected by TEE during preoperative anesthesia, preand pro-pulmonary vascular occlusion and pro-donor lung, and bronchus, pulmonary veins, pulmonary artery anastomoses.Left and right lung veins open and left and right pulmonary artery branch were key to observed.Pulmonary artery trunk and branch diameter, velocity of blood flow were measured.Results All left and right pulmonary artery,pulmonary vein images were given by TEE.TEE detected the normal blood flow velocity of pulmonary artery branches during pre-operation,average of 65 cm/s.After clipping the side of the pulmonary artery, the lateral pulmonary blood flow disappeared.TEE detected pulmonary veins,pulmonary artery anastomoses pro-operation.Except for 1 case of anastomotic pulmonary vein flow velocity increased,all the pulmonary vein and pulmonary artery branch anastomoses flow velocity increased slightly faster than those before transplantation (mean pulmonary artery branch of 160 cm/s, the average pulmonary vein 149 cm/s).Conclusions TEE can monitor diameter and flow velocity of pulmonary artery branch and pulmonary vein during lung transplantation,and can detect the rightventricular function.The views of left and right branch pulmonary artery and pulmonary vein branches play an important role during lung transplantation. Key words: Echocardiography,transesophageal; Lung transplantation

Idiopathic pulmonary artery aneurysm: Digital subtraction pulmonary angiography grossly underestimates the size of the aneurysm

Pulmonary artery aneurysm is a rare disease entity. The majority of cases are associated with congenital cardiovascular diseases, infection, and trauma; idiopathic pulmonary artery aneurysm is extremely rare. Although conventional and digital subtraction pulmonary angiography remains as the imaging modality of choice for the pulmonary vessels, it is invasive and sometimes may be inaccurate. With the advent of spiral computed tomographic angiography (CTA), pulmonary artery aneurysm can be diagnosed noninvasively and accurately. We report a case of a 68-year-old man with idiopathic pulmonary artery aneurysm of the descending branch of right pulmonary artery where the true caliber of the aneurysm was significantly underestimated in the digital subtraction pulmonary angiography. The literatures of this rare condition are reviewed with the emphasis on the application of CTA in this disease.

Congenital Left Pulmonary Artery Agenesis with the Defect of RML Branch of Right Pulmonary Artery

Congenital Left Pulmonary Artery Agenesis with the Defect of RML Branch of Right Pulmonary Artery