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Case Reports in Pulmonology 2024Lung sequestration is a subtype of congenital lung malformations; it is infrequently diagnosed in adults and is a rare cause of hemoptysis. The typical management of...
BACKGROUND
Lung sequestration is a subtype of congenital lung malformations; it is infrequently diagnosed in adults and is a rare cause of hemoptysis. The typical management of symptomatic lung sequestration is usually surgical, though intra-arterial embolization is becoming an acceptable alternative. . We report a case of a 36-year-old female patient who presented for an acute onset of hemoptysis. CT chest showed an intralobar sequestration of the right lower lobe lung segment. In addition to the sequestration, the chest imaging also revealed a number of associated abnormalities including double superior vena cava communicating through a bridge, absence of brachiocephalic venous trunk, cardiac dextroposition, and agenesis of the right middle lobe. . The transarterial embolization was selected for being mini-invasive and effective. It successfully controlled the bleed and led to complete regression of the sequestered lung on the follow-up CT chest several months later.
CONCLUSION
Successful management and complete regression are possible with mini-invasive intra-arterial embolization of lung sequestration. Although it is not uncommon to have associated congenital cardiopulmonary abnormalities with lung sequestration, however the exceptional abnormalities described in this case have never been reported before.
PubMed: 38756205
DOI: 10.1155/2024/1428495 -
Radiology Case Reports Aug 2024Reversal of blood flow has only been reported in the left internal jugular vein following interventions such as central venous catheter, dialysis shunt placement, or...
Reversal of blood flow has only been reported in the left internal jugular vein following interventions such as central venous catheter, dialysis shunt placement, or external compression from a tumor. We describe a rare case of chronic headache and hearing loss due to flow reversal in the left internal jugular vein and compensatory massive dilation of the right internal jugular vein. Flow reversal was caused by a prominent brachiocephalic trunk with subseqent compression of the vena brachiocephalica sinistra. Vascular anomalies and associated venous bypass circulation may be considered as a rare cause of non-specific malaise. Restoration of the physiological direction of blood flow should be discussed on an interdisciplinary basis given the unpredictable haemodynamic consequences.
PubMed: 38737176
DOI: 10.1016/j.radcr.2024.04.032 -
Aorta (Stamford, Conn.) May 2024Adequate myocardial protection is crucial for a successful cardiac surgery. In type A aortic dissection, standard methods of delivery of cardioplegic solution may not be...
Adequate myocardial protection is crucial for a successful cardiac surgery. In type A aortic dissection, standard methods of delivery of cardioplegic solution may not be adequately effective. Ineffectiveness may happen due to both features of the anatomy of the dissection and to peculiarities of the delivery method itself. We present a new method of delivering a cardioplegic solution using a Foley catheter through the orifice of the brachiocephalic trunk or the left common carotid artery.
PubMed: 38698621
DOI: 10.1055/s-0044-1780519 -
The American Journal of Case Reports Apr 2024BACKGROUND Aortic dissection is rare after coronary artery bypass grafting (CABG). It is a potentially fatal complication of cardiac surgery. Reoperation may pose...
BACKGROUND Aortic dissection is rare after coronary artery bypass grafting (CABG). It is a potentially fatal complication of cardiac surgery. Reoperation may pose problems with thoracotomy, adhesiolysis, and myocardial protection. No standard treatment guidelines exist for chronic aortic dissection after CABG. We present a case of chronic type A aortic dissection after cardiac surgery, which was successfully treated. CASE REPORT A 65-year-old female patient presented with a medical background of hypertension, type 2 diabetes mellitus, and hyperlipidemia.No connective tissue disorders were diagnosed. The aortic valve was tricuspid. Three years ago, she had undergone coronary artery bypass grafting involving four branches at a different medical facility. She was complaining of chest pain weeks after bypass surgery, which gradually increased. Aortic dissection was observed in the latest contrast-enhanced CT scan. Beginning from just above the sinotubular junction and reaching below the brachiocephalic trunk. Two grafts from the saphenous vein were patent, and one was lying just below the sternum. Cardiopulmonary support was initiated by cannulating the right femoral artery and vein. An opening in the ascending aorta exposed an intimal tear near the proximal anastomosis of the two great saphenous vein grafts. Antegrad Del-Nido cardioplegia was given through native ostia and functional bypass grafts. Proximal and then distal anastomosis of graft prosthesis was performed. A new venous graft was anastomosed to the apical part of the left anterior descending artery (LAD). This saphenous vein and the buttons of the two previous vein grafts were anastomosed to the prosthesis. The patient was successfully liberated from the heart-lung machine and exhibited favorable cardiac function in the postoperative period. CONCLUSIONS We can conclude that initial peripheral cannulation with a half dose of heparin provides a relatively bloodless and secure re-entry sternotomy. Del-Nido cardioplegia is easy to implement, safe, and gives surgeons enough time without interruptions to perform complex procedures fluently.  .
Topics: Female; Humans; Aged; Diabetes Mellitus, Type 2; Coronary Artery Bypass; Aortic Dissection; Aorta; Cardiac Surgical Procedures; Reoperation
PubMed: 38600678
DOI: 10.12659/AJCR.942673 -
Cureus Mar 2024Aortic dissection (AD) is a rare but often lethal condition if not properly and urgently treated. Most often, patients arrive with acute hemodynamic instability and...
Aortic dissection (AD) is a rare but often lethal condition if not properly and urgently treated. Most often, patients arrive with acute hemodynamic instability and ripping chest agony. The patient's life depends critically on a correct diagnosis made as soon as possible. We describe a 60-year-old man who arrived at the emergency room with symptoms of a brain stroke, including poor consciousness, left-sided weakness, and speech disturbance associated with hemodynamic instability, and chest pain. Thoracic aortic arch dissection was observed on CT angiography (CTA). In addition, CTA revealed that the dissection extends proximally into the left common carotid artery, left subclavian artery, brachiocephalic trunk, and right common carotid artery and distally to the left common iliac artery, coupled with significant stenosis of the left common iliac artery. Proper management of blood pressure (BP) parameters is life-saving for the patient. Since our hospital did not offer cardiothoracic surgery services, the patient was transferred to a different institution, where he received medical care immediately from an expert team and had surgery.
PubMed: 38576638
DOI: 10.7759/cureus.55564 -
Journal of Veterinary Science Mar 2024Aortic arch (AA) branching patterns vary among different mammalian species. Most previous studies have focused on dogs, whereas those on raccoon dogs remain unexplored.
BACKGROUND
Aortic arch (AA) branching patterns vary among different mammalian species. Most previous studies have focused on dogs, whereas those on raccoon dogs remain unexplored.
OBJECTIVES
The objective of this study was to describe the AA branching pattern in raccoon dogs and compare their morphological features with those of other carnivores.
METHODS
We prepared silicone cast specimens from a total of 36 raccoon dog carcasses via retrograde injection through the abdominal aorta. The brachiocephalic trunk (BCT) branching patterns were classified based on the relationship between the left and right common carotid arteries. The subclavian artery (SB) branching pattern was examined based on the order of the four major branches: the vertebral artery (VT), costocervical trunk (CCT), superficial cervical artery (SC), and internal thoracic artery (IT).
RESULTS
In most cases (88.6%), the BCT branched off from the left common carotid artery and terminated in the right common carotid and right subclavian arteries. In the remaining cases (11.4%), the BCT formed a bicarotid trunk. The SB exhibited various branching patterns, with 26 observed types. Based on the branching order of the four major branches, we identified the main branching pattern, in which the VT branched first (98.6%), the CCT branched second (81.9%), the SC branched third (62.5%), and the IT branched fourth (52.8%).
CONCLUSIONS
The AA branching pattern in raccoon dogs exhibited various branching patterns with both similarities and differences compared to other carnivores.
Topics: Animals; Raccoon Dogs; Aorta, Thoracic; Subclavian Artery; Carotid Artery, Common; Cadaver
PubMed: 38568833
DOI: 10.4142/jvs.23305 -
Korean Journal of Radiology Apr 2024To evaluate the image quality of novel dark-blood computed tomography angiography (CTA) imaging combined with deep learning reconstruction (DLR) compared to...
OBJECTIVE
To evaluate the image quality of novel dark-blood computed tomography angiography (CTA) imaging combined with deep learning reconstruction (DLR) compared to delayed-phase CTA images with hybrid iterative reconstruction (HIR), to visualize the cervical artery wall in patients with Takayasu arteritis (TAK).
MATERIALS AND METHODS
This prospective study continuously recruited 53 patients with TAK (mean age: 33.8 ± 10.2 years; 49 females) between January and July 2022 who underwent head-neck CTA scans. The arterial- and delayed-phase images were reconstructed using HIR and DLR. Subtracted images of the arterial-phase from the delayed-phase were then added to the original delayed-phase using a denoising filter to generate the final-dark-blood images. Qualitative image quality scores and quantitative parameters were obtained and compared among the three groups of images: Delayed-HIR, Dark-blood-HIR, and Dark-blood-DLR.
RESULTS
Compared to Delayed-HIR, Dark-blood-HIR images demonstrated higher qualitative scores in terms of vascular wall visualization and diagnostic confidence index (all < 0.001). These qualitative scores further improved after applying DLR (Dark-blood-DLR compared to Dark-blood-HIR, all < 0.001). Dark-blood DLR also showed higher scores for overall image noise than Dark-blood-HIR ( < 0.001). In the quantitative analysis, the contrast-to-noise ratio (CNR) values between the vessel wall and lumen for the bilateral common carotid arteries and brachiocephalic trunk were significantly higher on Dark-blood-HIR images than on Delayed-HIR images (all < 0.05). The CNR values were significantly higher for Dark-blood-DLR than for Dark-blood-HIR in all cervical arteries (all < 0.001).
CONCLUSION
Compared with Delayed-HIR CTA, the dark-blood method combined with DLR improved CTA image quality and enhanced visualization of the cervical artery wall in patients with TAK.
Topics: Female; Humans; Young Adult; Adult; Computed Tomography Angiography; Takayasu Arteritis; Prospective Studies; Deep Learning; Arteries; Radiographic Image Interpretation, Computer-Assisted; Algorithms; Radiation Dosage
PubMed: 38528696
DOI: 10.3348/kjr.2023.1078 -
Structural Heart : the Journal of the... Mar 2024The SENTINEL Cerebral Protection System is one of the most commonly used devices for embolic protection during transcatheter aortic valve replacement. However,...
The SENTINEL Cerebral Protection System is one of the most commonly used devices for embolic protection during transcatheter aortic valve replacement. However, successful deployment of the SENTINEL device is often challenging in patients with a bovine aortic arch anatomy using the standard technique and requires extensive manipulation in the aortic arch increasing the risk of stroke. We describe a novel and simple technique of 2-filter deployment of SENTINEL device in patients with bovine arch anatomy. In this technique, after the deployment of the proximal filter, the device is hyperflexed on itself facing the lateral aspect of the ascending aorta instead of facing the descending aorta, with its tip pointing toward the common origin of the left common carotid artery (LCCA) and brachiocephalic trunk. The guidewire is then advanced to the LCCA. Since the guidewire can pass either anterior or posterior to the device shaft, the device needs to be untwisted either by clockwise or counterclockwise motion, before pulling the device shaft back to engage the LCCA, after which the distal filter can be deployed. Computed tomography scans obtained for planning transcatheter aortic valve replacement should be reviewed for the presence of bovine aortic arch anatomy so that this technique can be deployed directly, thereby reducing manipulations in the aortic arch, saving time, and not requiring additional equipment.
PubMed: 38481710
DOI: 10.1016/j.shj.2023.100228 -
Ear, Nose, & Throat Journal Mar 2024Vascular variations are prevalent among the human population. However, the occurrence of anatomical variations in the inferior thyroid artery originating directly from...
Vascular variations are prevalent among the human population. However, the occurrence of anatomical variations in the inferior thyroid artery originating directly from the brachiocephalic trunk (BCT) is exceptionally rare, as confirmed by numerous research studies. In addition, reliable departmental statistics reveal that the incidence rate of retrosternal goiter is approximately 19%. In this case study, the variation blood vessels in the neck were accidentally found and analyzed. Simultaneously, we conducted an analysis on the clinical significance of a rare anatomical variation. The study focused on a 60-year-old female patient who underwent a surgery for retrosternal goiter, during which it was discovered that the inferior thyroid artery originated from the BCT. Our report presented a unique case involving this particular combination of anatomical variations within the BCT. The anatomical variation reported in our study will effectively reduce the risk of patients and enhance our comprehension of this anatomy's characteristics, thereby avoiding the occurrence of iatrogenic complications.
PubMed: 38481116
DOI: 10.1177/01455613241239529