scholarly journals P233 A new onset pulmonary artery stenosis in a young man

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Scheggi ◽  
C Mazzoni
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Ct Scan ◽  
Heart Function ◽  
Main Pulmonary Artery ◽  
Pulmonary Artery Stenosis ◽  
Maximal Velocity ◽  
Primary Tumors ◽  
Flow Acceleration ◽  
Presenting Symptoms

Abstract Background Poorly differentiated and undifferentiated sarcomas are the most common primary tumors of the pulmonary arteries. They usually affect large caliber vessels and present with predominantly intraluminal growth. Dyspnea, cough, chest pain, and hemoptysis are the most common presenting symptoms; patients may have signs of chronic pulmonary hypertension. Clinical and imaging manifestations can mimic pulmonary embolism. The overall prognosis is poor combined therapy with surgical resection and chemo-radiotherapy offers the best survival rates. Case presentation A 31-year-old male was referred to our department because of recent onset dyspnea, a pre-syncopal episode and a new heart murmur. He had normal spirometry results but a significant desaturation during the 6MWT. A thoracic CT scan showed an incremented diameter of the pulmonary artery.The echocardiogram showed the presence of a mass with irregular borders attached to the pulmonary trunk almost obliterating its lumen. The mass determined a flow acceleration with maximal velocity of 3.8 m/sec, and a peak gradient of 60mmHg; Doppler findings on the pulmonary valve and right heart function were within normal values. Compression ultrasonography ruled out the presence of deep vein thrombosis. The lesion showed a dishomogeneous impregnation in the contrastographic phase at cardiac MRI and had an intense glucidic metabolism at a PET-CT scan. These findings were highly suggestive of an angiosarcoma of the pulmonary artery. Biopsy specimens were taken through bronchoscopy. The patient then decided to continue treatment in another hospital, where the histologic samples were sent; the cytologic results showed atypical cellular elements. The patient died a few months later. Discussion The presence of a unique mass in the main pulmonary artery or proximal branches and rapidly progressive dyspnea in a patient at low risk of pulmonary embolism should raise the suspicion of primary sarcoma of the pulmonary artery, which is a rare but aggressive tumor with a very poor prognosis. Abstract P233 Figure.

scholarly journals Evaluation of the Therapeutic Effect of Pulmonary Embolism by CT Pulmonary Angiography Combined With Clinical Indexes

2021 ◽  
Author(s):  
Meng Yuan ◽  
XinYuan Cui ◽  
ChunXue Yang ◽  
XinYang Zhang ◽  
DeLi Zhao ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Heart Function ◽  
Main Pulmonary Artery ◽  
Pulmonary Angiography ◽  
Trunk Diameter ◽  
Right Heart Function ◽  
Before And After ◽  
Pulmonary Artery Obstruction ◽  
D Dimer

Abstract Background To evaluate the value of CT pulmonary angiography (CTPA) in evaluating the therapeutic efficacy of pulmonary embolism (PE) through the study of CT pulmonary artery obstruction index (PAOI),right ventricular function parameters and some clinical indexes related to coagulation function and cardiac function injury.Materials and methods Select 30 patients with pulmonary embolism who underwent CTPA examination before and after treatment in our hospital, sort out their CTPA images before and after treatment, and obtain PAOI and right heart function parameters, including ascending aorta diameter (AAd), main pulmonary artery diameter (MPAd), ratio of main pulmonary artery diameter to ascending aorta diameter (MPAd/AAd), right pulmonary artery trunk diameter (RPAd), left pulmonary artery trunk diameter (LPAd), the ratio of the maximum short axis diameter of the right ventricle to the maximum short axis diameter of the left ventricle (RVd/LVd), and calculate the pulmonary artery obstruction index (PAOI).At the same time obtain the required clinical indicators, including serum D-dimer, N-terminal B-type natriuretic peptide precursor (NT-proBNP), cardiac troponin I (cTnI), myocardial enzyme profile (aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK)).Results MPAd, RPAd, LPAd, RVd / LVd, PAOI, D-dimer, cTnI, CK, LDH, AST had significant changes after treatment (P < 0.05), while the other parameters and indexes had no significant differences before and after treatment (P > 0.05). PAOI is positively correlated with RVd/LVd, MPAd, D-dimer. The correlation coefficient ranges from 0.281 to 0.423, among which, the correlation with D-dimer is the closest, with a correlation coefficient of 0.423. There was no significant correlation between other parameters and PAOI (P < 0.05).Conclusion CTPA is of great significance in evaluating the severity of pulmonary embolism, right heart function and therapeutic efficacy.

scholarly journals A new-onset pulmonary artery stenosis in a young man: case report

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Francesco Vanni ◽  
Valentina Scheggi ◽  
Niccolò Marchionni ◽  
Pier Luigi Stefàno
Keyword(s):  
Pulmonary Artery ◽  
Correct Diagnosis ◽  
Pulmonary Arteries ◽  
Pulmonary Artery Stenosis ◽  
Main Trunk ◽  
Recent Onset ◽  
Flow Acceleration ◽  
Presenting Symptoms ◽  
Positron Emission ◽  
Neo Adjuvant Chemotherapy

Abstract Background  Poorly differentiated and undifferentiated sarcomas are the most common primary tumours of the pulmonary arteries. They usually affect large-calibre vessels and present with predominantly intraluminal growth. Dyspnoea, cough, chest pain, and haemoptysis are the most common presenting symptoms. Clinical and imaging manifestations can mimic pulmonary embolisms and correct diagnosis may require multimodal imaging. The overall prognosis is poor; however, early diagnosis and complete surgical resection seem to improve the prognosis. Case summary  A 31-year-old male was admitted to our department after a pre-syncopal episode associated with dyspnoea of recent onset. Echocardiography showed a mass with irregular borders attached to the pulmonary artery trunk, almost obliterating its lumen and determining a flow acceleration with a peak velocity and gradient, respectively, of 3.8 m/s and 60 mmHg. At cardiac magnetic resonance imaging and positron emission tomography-computed tomography scan, the mass had inhomogeneous contrast impregnation and an intense 18-fluorodeoxyglucose uptake, both findings are highly suggestive of an angiosarcoma of the pulmonary artery. Biopsy specimens were taken through bronchoscopy but the material was insufficient for diagnosis. The patient decided to continue treatment in another hospital, where he died a few months later. Discussion  The presence of a unique mass involving the main trunk of the pulmonary artery or proximal branches associated with rapidly progressive dyspnoea in a patient at low risk for pulmonary embolism should raise the suspicion of primary sarcoma of the pulmonary artery. There are no guidelines for the treatment. Surgery and neo/adjuvant chemotherapy are reported in literature but burdened by bias and concerning a small number of cases.

scholarly journals Evaluation of the Therapeutic Effect of Pulmonary Embolism by CT Pulmonary Angiography Combined With Clinical Indexes

2021 ◽  
Author(s):  
Meng Yuan ◽  
XinYuan Cui ◽  
ChunXue Yang ◽  
XinYang Zhang ◽  
DeLi Zhao ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Heart Function ◽  
Main Pulmonary Artery ◽  
Pulmonary Angiography ◽  
Trunk Diameter ◽  
Right Heart Function ◽  
Before And After ◽  
Pulmonary Artery Obstruction ◽  
D Dimer

Abstract BackgroundTo evaluate the value of CT pulmonary angiography (CTPA) in evaluating the therapeutic efficacy of pulmonary embolism (PE) through the study of CT pulmonary artery obstruction index (PAOI), right ventricular function parameters and some clinical indexes related to coagulation function and cardiac function injury.Materials and methodsSelect 30 patients with pulmonary embolism who underwent CTPA examination before and after treatment in our hospital, sort out their CTPA images before and after treatment, and obtain PAOI and right heart function parameters, including ascending aorta diameter (AAd), main pulmonary artery diameter (MPAd), ratio of main pulmonary artery diameter to ascending aorta diameter (MPAd/AAd), right pulmonary artery trunk diameter (RPAd), left pulmonary artery trunk diameter (LPAd), the ratio of the maximum short axis diameter of the right ventricle to the maximum short axis diameter of the left ventricle (RVd/LVd), and calculate the pulmonary artery obstruction index (PAOI).At the same time obtain the required clinical indicators, including serum D-dimer, N-terminal B-type natriuretic peptide precursor (NT-proBNP), cardiac troponin I (cTnI), myocardial enzyme profile (aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK)).ResultsMPAd, RPAd,LPAd,RVd / LVd, PAOI, D-dimer, cTnI, CK, LDH, AST had significant changes after treatment (P < 0.05), while the other parameters and indexes had no significant differences before and after treatment (P > 0.05). PAOI is positively correlated with RVd/LVd, MPAd, D-dimer. The correlation coefficient ranges from 0.281 to 0.423, among which, the correlation with D-dimer is the closest, with a correlation coefficient of 0.423. There was no significant correlation between other parameters and PAOI (P < 0.05).ConclusionCTPA is of great significance in evaluating the severity of pulmonary embolism, right heart function and therapeutic efficacy.

scholarly journals Saddle pulmonary emboli: an unusual presentation

CJEM ◽  
2009 ◽  
Vol 11 (06) ◽  
pp. 558-559
Author(s):  
Truptesh H. Kothari ◽  
Shivangi Kothari ◽  
Mahima Pandey ◽  
Harshit Khara ◽  
Nishant Dhungel
Keyword(s):  
Pulmonary Artery ◽  
Troponin I ◽  
Femoral Vein ◽  
Main Pulmonary Artery ◽  
Vena Cava ◽  
Factor V Leiden ◽  
Superficial Femoral Vein ◽  
Presenting Symptoms ◽  
Coronary Syndrome ◽  
The Right

A 38-year-old man with a history of polyposis syndrome diagnosed 3 years previously, with poor compliance for follow-up, presented to the emergency department with symptoms of retrosternal chest pain associated with dizziness and shortness of breath. His blood pressure was 94/43 mm Hg, his pulse was 123 beats/min and he had an oxygen saturation of 84% on room air. The patient’s initial laboratory results showed a hemoglobin of 80 g/L and blood gas with a pH of 7.23. He had a normal chest radiograph and electrocardiogram, but had an elevated troponin I at 0.12 μg/L. He was given acetylsalicylic acid for suspicion of acute coronary syndrome. On physical examination, the patient was found to have right calf tenderness. With this finding and the presenting symptoms, he underwent computed tomography angiography (CTA) of the chest. The chest CTA showed a massive saddle embolus with a filling defect completely occluding the right pulmonary artery and extending through the main pulmonary artery segment to involve the left pulmonary artery. There were also diffuse filling defects involving bilateral pulmonary segmental arteries (Fig. 1 and Fig. 2). The patient received alteplase and underwent a workup for a hypercoagulable state. His workup revealed positive anticardiolipin antibodies and factor V Leiden. The Doppler ultrasound of his lower extremities showed an extensive thrombus measuring more than 6 cm extending in the right superficial femoral vein. The patient was then referred for placement of an inferior vena cava filter.

scholarly journals Main Pulmonary Artery Stenosis Caused by Fibrocalcified Mass in a Young Infant

2002 ◽  
Vol 17 (4) ◽  
pp. 560 ◽  
Author(s):  
Heon Seok Han ◽  
Jeong Hyun Park ◽  
Deok Soo Kim ◽  
Seog Jae Lee ◽  
Jang Soo Hong ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Young Infant ◽  
Main Pulmonary Artery ◽  
Artery Stenosis ◽  
Pulmonary Artery Stenosis

scholarly journals Isolated Pulmonary Infective Endocarditis with Septic Pulmonary Embolism Complicating a Right Ventricular Outflow Tract Obstruction: Scarce and Devious Presentation

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Abdelrahmen Abdelbar ◽  
Raed Azzam ◽  
Kok Hooi Yap ◽  
Ahmed Abousteit
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Valve ◽  
Main Pulmonary Artery ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Diagnostic Tools ◽  
Septic Pulmonary Embolism

We present a case of a fifty-three-year-old male who presented with severe sepsis. He had been treated as a pneumonia patient for five months before the admission. Investigations revealed isolated pulmonary valve endocarditis and septic pulmonary embolism in addition to undiagnosed right ventricular outflow tract (RVOT) obstruction. The patient underwent surgery for the relief of RVOT obstruction by substantial muscle resection of the RVOT, pulmonary artery embolectomy, pulmonary valve replacement, and reconstruction of RVOT and main pulmonary artery with two separate bovine pericardial patches. He was discharged from our hospital after 6 weeks of intravenous antibiotics. He recovered well on follow-up 16 weeks after discharge. A high-suspicion index is needed to diagnose right-side heart endocarditis. Blood cultures and transesophageal echocardiogram are the key diagnostic tools.

scholarly journals Salvage of Suboptimal Enhancement of Pulmonary Artery in Pulmonary CT Angiography Studies: Rapid kVp Switch Dual Energy CT Experience

2020 ◽  
Vol 17 (2) ◽  
Author(s):  
Selen Bayraktaroglu ◽  
Akın Cinkooglu ◽  
Naim Ceylan ◽  
Recep Savas
Keyword(s):  
Pulmonary Embolism ◽  
Image Quality ◽  
Pulmonary Artery ◽  
Imaging Modality ◽  
Main Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Average Increase ◽  
Noise Ratio

Background: Multidetector computed tomography (MDCT) angiography is considered as the gold standard imaging modality in the evaluation of acute pulmonary embolism. Optimum vascular enhancement is critical for MDCT studies. The suboptimal opacification in pulmonary artery could be salvaged using low-energy virtual monoenergetic images (VMI) at rapid kVp switch dual energy CT. Objectives: To explore the potential improvement in pulmonary artery opacification and to assess the change in image quality parameters in VMI using fast switch kVp dual energy CT. Patients and Methods: The CT images of 877 patients who were referred with a preliminary diagnosis of pulmonary embolism were reviewed. Sixty patients with suboptimal enhancement (< 200 Hounsfeld Unit [HU]) were involved. Standard images (140 kVp) and VMI from 40 to 120 keV were generated. Attenuation, noise, signal to noise ratio (SNR) and contrast to noise ratio (CNR) were measured in the pulmonary artery. Using VMIs, the best image was determined as the image with the main pulmonary artery opacification greater than 200 HU and image quality ≥ 3. Fifty six studies that met these criteria were considered as salvaged. At this best energy level, quantitative parameters were compared with standard images. Results: The mean attenuation of pulmonary arteries was 169.80 HU in standard images in patients with suboptimal enhancement. The attenuations of VMIs at 40, 45, 50, 55, 60, 65, and 70 keV were significantly higher than standard images (P < 0.001). Similar findings were observed with SNR and CNR. In the salvaged patients, the average increase in mean pulmonary artery attenuation was 62% (from 172.61 ± 23.4 to 280.55 ± 40.7), the average increase in SNR was 38% (from 12.1 ± 5.3 to 16.7 ± 7.1) and the average increase in CNR was 48% (9.2 ± 4.3 to 13.7 ± 6) (P < 0.001). Conclusions: Low keV VMI reconstructions significantly increase pulmonary artery attenuation, CNR and SNR compared to standard image reconstructions. Suboptimal CT studies could be salvaged using low keV VMIs.

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