Thoracic Stent Graft Accompanied by Coil Embolization for Pulmonary Sequestration

2019 ◽  
Vol 14 (2) ◽  
pp. 168-173 ◽  
Author(s):  
Fatima G. Wilder ◽  
Sarah Z. Minasyan
Keyword(s):  
Back Pain ◽  
Chest Pain ◽  
Ct Angiography ◽  
Stent Graft ◽  
Coil Embolization ◽  
Lower Lobe ◽  
Pulmonary Sequestration ◽  
Type I ◽  
Anomalous Artery ◽  
Thoracic Stent Graft

Thoracic stent graft plus coil embolization is a promising option for management of pulmonary sequestrations. Here we present the case of a 43-year-old male with chronic recurrent chest pain and hemoptysis that was incidentally identified as having a Pryce Type I pulmonary sequestration. The patient had a known history of gastritis, alcohol abuse, chronic leg and back pain, and was incidentally found to have an anomalous artery from the descending thoracic aorta to the left lower lobe. Due to recurrent hemoptysis and refractory back pain with no other identifiable etiology, he was consented for coil embolization and thoracic endovascular aortic repair. In conjunction with interventional radiology, coil embolization of the aberrant thoracic artery was performed under fluoroscopic guidance with good graft coverage of the aberrant artery with an endovascular graft. The patient’s postoperative recovery was uneventful and he reported a decrease in his chest pain. Repeat imaging including chest X-ray and CT angiography were performed prior to discharge. CT angiography demonstrated good positioning of the coils as well as the stent graft. The patient was discharged on postoperative day 1. Surgical intervention with ligation of the anomalous vessel has historically been the primary intervention for patients with Pryce Type I sequestrations, and it has yielded satisfactory results. However, thoracic stent graft in addition to coil embolization is a minimally invasive management option that should be considered as the first line of treatment because of the minimal physiologic burden on the patient and quicker recovery as compared to traditional thoracotomy.

scholarly journals Intralobar Pulmonary Sequestration with Anomalous Artery Arising from the Celiac Trunk

Surgeries ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 105-112
Author(s):  
Alexandr E. Mashkov ◽  
Johannes M. Mayr ◽  
Andrei V. Bobylev ◽  
Vyacheslav V. Slesarev
Keyword(s):  
Lower Lobe ◽  
Celiac Trunk ◽  
Pulmonary Sequestration ◽  
Lung Parenchyma ◽  
Left Lower Lobe ◽  
Normal Lung ◽  
Large Artery ◽  
Anomalous Artery ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography

Pulmonary saequestration is a rare congenital malformation characterized by a dysplastic portion of lung parenchyma supplied by an anomalous artery originating from the aorta or its branches. The worldwide incidence of pulmonary sequestration among all congenital lung malformations in children ranges from 1.5% to 6.4%. There are two main types of pulmonary sequestration according to the localization of the malformation, i.e., intrapulmonary sequestration (dysplastic tissue located inside a lobe of the normal lung) and extrapulmonary sequestration. Our case presentation aims to make physicians aware of this rare anomaly which may be difficult to diagnose because of its oligosymptomatic course prior to first presentation. We present the case of a 10-year-old girl who suffered from a second episode of prolonged pneumonia of the left lower lobe. Contrast-enhanced-computed-tomography (CT) scan of the thoraco-abdominal segment of the aorta and its branches revealed intrapulmonary sequestration localized at the left lower lobe of the lung. The intrapulmonary sequester was perfused by a large artery arising from the celiac trunk. The girl underwent open surgery with ligation of the anomalous feeding artery and atypical pulmonary resection of the affected area of the left lower lobe. Postoperatively, the child recovered without any complications.

Long-term Results of Thoracic Endovascular Aortic Repair Using a Low-Profile Stent-Graft

2020 ◽  
pp. 152660282095241
Author(s):  
Efthymios Beropoulis ◽  
Stefano Fazzini ◽  
Martin Austermann ◽  
Giovanni B. Torsello ◽  
Sarah Damerau ◽  
...  
Keyword(s):  
Stent Graft ◽  
Clinical Success ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Aortic Aneurysms ◽  
Long Term Results ◽  
Type I ◽  
Minimum Diameter ◽  
Vessel Anatomy ◽  
Thoracic Stent Graft

Purpose To evaluate the long-term results associated with the Zenith Alpha thoracic stent-graft, which was designed to address challenging access vessel anatomy. Materials and Methods A retrospective analysis was conducted of 44 consecutive patients (mean age 72.5±8.3 years; 25 men) treated in a single center between August 2010 and October 2014 with a minimum follow-up of 5 years in survivors. The Zenith Alpha thoracic stent-graft was used to treat thoracic aortic aneurysms (n=37), thoracoabdominal aortic aneurysm (n=5), or penetrating aortic ulcer (n=2). Ten patients (23%) were American Society of Anesthesiologists class IV, and 9 (20%) had nonelective procedures. Access vessel anatomy was demanding (mean minimum diameter 5.4 mm, tortuosity index 1.3). The primary endpoint at 5 years was ongoing clinical success (freedom from aneurysm-/procedure-related death, secondary intervention, type I or III endoleak, infection, thrombosis, aneurysm expansion, rupture, or conversion). Secondary endpoints were freedom from all-cause mortality, device migration, stent fractures, fabric erosions, endoleaks, neurological events, and access vessel complications. Results The ongoing clinical success was 84% (37 of 44 patients) owing to 4 aneurysm-related deaths (9%), 3 type I or III endoleaks (1 in a deceased patient), and 1 aneurysm expansion without detectable endoleak. There were 3 access vessel complications (7%), and no postoperative neurological events. Migration was observed in 2 cases (5%). There were no stent fractures or fabric tears. Conclusion Despite the alterations in stent-graft design and material to reduce profile, the Zenith Alpha thoracic stent-graft showed favorable long-term results even in multimorbid patients with demanding iliac anatomy.

scholarly journals Intralobar pulmonary sequestration (Pryce type I) with an anomalous artery 18mm in diameter; a case report.

1992 ◽  
Vol 6 (6) ◽  
pp. 691-698
Author(s):  
Kazuhiko Kataoka ◽  
Hiroyuki Nishiyama ◽  
Tetsushi Saishoji ◽  
Mitsuyo Nishimura ◽  
Kenro Takahashi
Keyword(s):  
Case Report ◽  
Pulmonary Sequestration ◽  
Type I ◽  
Anomalous Artery ◽  
Intralobar Pulmonary Sequestration

Clinical relevance of myocardial bridging detected by coronary CT angiography in patients with atypical chest pain

2019 ◽  
Vol 67 (1) ◽  
Author(s):  
Ludovico La Grutta ◽  
Roberto Malagò ◽  
Patrizia Toia ◽  
Giulia Tabacco ◽  
Tommaso Smeraldi ◽  
...  
Keyword(s):  
Chest Pain ◽  
Ct Angiography ◽  
Clinical Relevance ◽  
Coronary Ct Angiography ◽  
Myocardial Bridging ◽  
Atypical Chest Pain ◽  
Coronary Ct

scholarly journals Diagnostic markers for discriminating between acute aortic dissection and acute myocardial infarction during the pre-hospital phase: analysis of 3,195 cases

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Watanabe ◽  
H Yoshino ◽  
T Takahashi ◽  
M Usui ◽  
K Akutsu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Back Pain ◽  
Chest Pain ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Diagnostic Markers ◽  
Network Database ◽  
History Of ◽  
First Contact

Abstract   Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment. The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database. We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of >60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded. We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P<0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P<0.001), history of hypertension (73% vs. 58%, P<0.001), SBP ≥150 mmHg (39% vs. 22%, P<0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P<0.001), and back pain with SBP <90 mmHg (4.5% vs. 0.1%, P<0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P<0.001), dyslipidaemia (17% vs. 42%, P<0.001), and history of smoking (48% vs. 61%, P<0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P<0.001), back pain with SBP <90 mmHg (OR 68, 95% CI 16–297, P<0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P<0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs <90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively. In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP <90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain. Funding Acknowledgement Type of funding source: None

scholarly journals Assessing The Appropriateness And Effectiveness Of Coronary Ct Angiography In Covid-19 Patients With Chest Pain

2021 ◽  
Vol 15 (4) ◽  
pp. S2
Author(s):  
L. Chen ◽  
R. Marfatia ◽  
J. Burkowski ◽  
K. Rapelje ◽  
T. Christian ◽  
...  
Keyword(s):  
Chest Pain ◽  
Ct Angiography ◽  
Coronary Ct Angiography ◽  
Coronary Ct
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