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Surgery Today Sep 2020To identify and clarify the comprehensive anatomic patterns in the left lower lobe (LLL).
PURPOSE
To identify and clarify the comprehensive anatomic patterns in the left lower lobe (LLL).
METHODS
Using computed tomography (CT) imaging data, including that obtained using three-dimensional CT, we reviewed the anatomic patterns of the pulmonary vessels and bronchi in the left lungs of 539 patients, focusing on the LLL.
RESULTS
The two-stem type in A was observed in 131 (24.7%) patients and the three-stem type in A was observed in 11 (2.1%) patients. The independent two-stem type in B was observed in four (0.75%) patients. The B with independent branching from the basal bronchi was observed in 42 (7.9%) patients. B* was observed in 129 (24.0%) patients and B* was accompanied by A* in all patients. An extrapericardial common trunk of the left pulmonary veins was identified in five patients (0.93%).
CONCLUSION
We identified various bronchovascular patterns in the LLL of a large number of patients. Our results provide useful information for anatomic pulmonary resection, especially segmentectomy.
Topics: Aged; Anatomic Variation; Bronchi; Female; Humans; Imaging, Three-Dimensional; Lung; Male; Pneumonectomy; Pulmonary Artery; Pulmonary Veins; Tomography, X-Ray Computed
PubMed: 32200429
DOI: 10.1007/s00595-020-01991-y -
Iranian Journal of Medical Sciences Jul 2022Chronic pulmonary thromboembolism (CTEPH) is an unusual complication of acute pulmonary embolism (PE), which is now considered to be treatable. In modern multi-detector...
BACKGROUND
Chronic pulmonary thromboembolism (CTEPH) is an unusual complication of acute pulmonary embolism (PE), which is now considered to be treatable. In modern multi-detector scanners, a detailed evaluation of pulmonary artery geometry is currently possible. This study aimed to evaluate the changes in pulmonary artery bifurcation angle (PABA) in the follow-up computed tomography angiography (CTA) of patients with acute PE.
METHODS
In this cross-sectional study, the records of two tertiary-level academic hospitals were gathered from 2012 to 2019. Pulmonary artery (PA) bifurcation angle and diameter were measured. Chi square test, independent samples test, Mann-Whitney, and Pearson's tests were employed to compare data. To evaluate the cut-off point, we utilized receiver operating characteristic (ROC) curve analysis. The accuracy, sensitivity, and specificity of pulmonary artery bifurcation angle changes were calculated. A P value <0.05 was considered to be significant.
RESULTS
Forty-six patients were included in the study. No significant differences were found between patients with and without CTEPH, and PABA in the dimeters of PA trunk, right PA, and left PA in the first CTA images (P values of 0.151, 0.142, 0.891, and 0.483, respectively), while in the secondary CTA, the mean PABA was significantly smaller in patients with CTEPH (P=0.011). In the receiver operating characteristic (ROC) analysis, delta angle revealed an area under the curve of 0.745 and an optimal cutoff of 0, leading to a sensitivity of 64%, specificity of 87%, and accuracy of 76% for diagnosing CTEPH.
CONCLUSION
We showed a significant decrease in PABA in patients developing CTEPH. This parameter can be easily measured in lung CTA.
Topics: 4-Aminobenzoic Acid; Acute Disease; Cross-Sectional Studies; Humans; Pulmonary Artery; Pulmonary Embolism; Retrospective Studies
PubMed: 35919084
DOI: 10.30476/IJMS.2021.88058.1926 -
The Journal of Thoracic and... Apr 2022
Topics: Humans; Lung; Pulmonary Artery; Vascular Surgical Procedures
PubMed: 34521511
DOI: 10.1016/j.jtcvs.2021.08.044 -
European Heart Journal Nov 2022
Topics: Humans; Pulmonary Artery; Aneurysm; Fistula; Heart Defects, Congenital; Coronary Artery Disease
PubMed: 35938849
DOI: 10.1093/eurheartj/ehac441 -
Current Problems in Cardiology Jun 2023Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥20 mm Hg at rest as assessed by right cardiac catheterization. It has... (Review)
Review
Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥20 mm Hg at rest as assessed by right cardiac catheterization. It has a median survival nowadays of 6 years, compared to 2.8 years in the 1980s. A pulmonary artery aneurysm (PAA) is the focal dilation of a blood vessel involving all 3 layers of the vessel wall; they have a diameter greater than 4 cm measured in the trunk of the pulmonary artery. PAAs can be classified into proximal (or central) and peripheral. The clinical manifestations of PAA are primarily nonspecific, and most patients remain undiagnosed, even those with large PAA, due to its silent course; however, clinical manifestations occur unless when there are complications such as bronchial or tracheal compression (leading to cough and dyspnea), dissection, or rupture (leading to hemoptysis). PAH is observed in 66% of patients with PAA. PA dissections are usually associated with PAH; 80% of dissections occur in the main pulmonary trunk. Although there is no clear guideline for the best treatment of PAA, surgery is indicated in patients with a pulmonary trunk aneurysm >5.5 cm. It has been observed that patients in the PAH group associated with congenital heart disease tend to develop PAA more commonly. Those with PAH associated with connective tissue disease have a smaller diameter of PA dilation. This report presents a comprehensive review of PAA, discussing critical aspects of the clinical and imaging diagnosis, hemodynamics, and treatment. A comprehensive updated literature review is included; we believe this article will interest cardiopulmonologists.
Topics: Humans; Hypertension, Pulmonary; Pulmonary Artery; Aneurysm
PubMed: 36773948
DOI: 10.1016/j.cpcardiol.2023.101645 -
Journal of Medical Imaging and... Feb 2017This study assessed the rate of indeterminate CT pulmonary angiogram (CTPA) in a general hospital and evaluated potential contributing factors to an indeterminate CTPA...
INTRODUCTION
This study assessed the rate of indeterminate CT pulmonary angiogram (CTPA) in a general hospital and evaluated potential contributing factors to an indeterminate CTPA and patients' eventual clinical outcome.
METHODS
Four hundred and three consecutive CTPA and their finalised report from 01/08/2012 to 05/12/2012 at Waitemata DHB were reviewed retrospectively. Patient demographics, scan parameters and average Hounsfield unit (HU) of the main pulmonary trunk (PT) and likely cause of indeterminate study were documented. Studies were categorised into diagnostic, suboptimal or non-diagnostic studies. Univariate and multiple regression analyses were employed.
RESULTS
Six per cent (n = 24) of the studies were deemed indeterminate which included suboptimal and non-diagnostic studies. Seven pregnant patients were scanned during the study period and four of the seven studies were deemed indeterminate. In univariate analysis, predictors of indeterminate studies included 'weight' (P = 0.022), 'average HU of PT' (P < 0.0001) and 'effective dose' (P = 0.0003). In the multivariate logistic regression model, only 'average HU of PT' was associated with indeterminate studies (OR = 0.99, 95%CI: 0.99, 1.00). Twelve of 24 indeterminate studies had suboptimal pulmonary enhancement with causes including suboptimal timing of contrast bolus, hyperdynamic state due to pregnancy and transient interruption of contrast. Three patients had excessive noise due to body habitus. Eight studies had motion artefacts and one patient had left lower lobe pneumonia which decreased the accuracy. A third of the indeterminate studies were clinically considered as negative by referring clinicians.
CONCLUSIONS
Pulmonary trunk average Hounsfield unit is a predictor of indeterminate CT pulmonary angiogram.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Angiography; Female; Humans; Male; Middle Aged; Pulmonary Artery; Pulmonary Embolism; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Young Adult
PubMed: 27470054
DOI: 10.1111/1754-9485.12500 -
The Journal of Thoracic and... Nov 2021
Topics: Heart Ventricles; Humans; Hypoplastic Left Heart Syndrome; Models, Statistical; Pulmonary Artery
PubMed: 33589314
DOI: 10.1016/j.jtcvs.2021.01.018 -
Pediatric Pulmonology May 2015Vascular rings are congenital anomalies that lead to variable degrees of respiratory problems or feeding difficulties by forming a complete or partial ring compressing... (Review)
Review
Vascular rings are congenital anomalies that lead to variable degrees of respiratory problems or feeding difficulties by forming a complete or partial ring compressing the trachea, the bronchi, and the esophagus. The clinical diagnosis of vascular rings is often challenging for the pediatrician because the clinical manifestations are heterogeneous and nonspecific. Symptoms can vary from wheezing, stridor, dyspnea, and/or dysphagia to life-threatening conditions; however, they may not be present. The aim of this study is to review the recent literature on this subject and describe new developments in diagnostics and imaging.
Topics: Aorta, Thoracic; Brachiocephalic Trunk; Bronchi; Deglutition Disorders; Dyspnea; Esophagus; Humans; Infant; Pressure; Pulmonary Artery; Respiratory Sounds; Subclavian Artery; Trachea; Vascular Malformations
PubMed: 25604054
DOI: 10.1002/ppul.23152 -
European Journal of Cardio-thoracic... Nov 2021
Topics: Humans; Pulmonary Artery; Tissue Engineering; Tissue Scaffolds
PubMed: 34269386
DOI: 10.1093/ejcts/ezab265 -
AJR. American Journal of Roentgenology Dec 2020The objective of our study was to compare morphologic and functional dual-energy CT (DECT) parameters in patients with chronic thromboembolic disease (CTED) and chronic...
The objective of our study was to compare morphologic and functional dual-energy CT (DECT) parameters in patients with chronic thromboembolic disease (CTED) and chronic thromboembolic pulmonary hypertension (CTEPH). Using the local CTEPH registry, we identified 28 patients with CTED and 72 patients with CTEPH. On each DECT examination, a clot burden score was calculated by assigning the following scores for chronic changes by location: pulmonary trunk, 5; each main pulmonary artery (MPA), 4; each lobar branch, 3; each segmental branch, 2; and each subsegmental branch, 1. The total clot burden score was calculated by adding the individual scores from both lungs. Functional parameters were assessed using perfused blood volume (PBV) maps and included lung enhancement (in Hounsfield units), percentage of PBV, MPA peak enhancement (in Hounsfield units), maximum enhancement corresponding to 100, and the ratio of MPA peak enhancement to lung enhancement. A perfusion defect (PD) score was calculated by assigning 1 point to each segmental PD. Patients with CTED and patients with CTEPH were matched using propensity score matching to account for potential confounders. After matching, the CTEPH group showed a higher PD score than the CTED group and unilateral disease was more common in the CTED group than in the CTEPH group. In the unmatched sample, patients with CTED showed increased percentages of PBV for both lungs (PBV total) and for the right lung as compared with the CTEPH group (adjusted = 0.040 and 0.028, respectively); after adjustment for clot burden, the difference between groups was still noted but was not statistically significant. No statistically significant differences were noted in the various functional DECT parameters after propensity score matching. Patients with CTED show anatomic and functional changes in the pulmonary vasculature and lung parenchyma similar to those seen in patients with CTEPH. Functional DECT parameters support the observation that CTED is an intermediate clinical phenotype in the population with chronic pulmonary embolism.
Topics: Chronic Disease; Female; Humans; Hypertension, Pulmonary; Male; Middle Aged; Propensity Score; Pulmonary Artery; Pulmonary Embolism; Radiography, Dual-Energy Scanned Projection; Registries; Retrospective Studies; Thromboembolism; Tomography, X-Ray Computed
PubMed: 32991219
DOI: 10.2214/AJR.19.22743