Transpleural systemic artery to pulmonary vessel fistulas: Imaging characteristics and management of an uncommon entity

Systemic arterial to pulmonary vessel fistulas may develop in the setting of pleural inflammation and/or injury. Bronchial arteries are the most commonly involved vessels, with recruitment often occurring in chronic diseases such as tuberculosis and cystic fibrosis. Rarely, transpleural systemic arteries that directly communicate with the pulmonary vasculature may develop in the presence of pleural injury or chronic inflammation. The clinical presentation and management of three cases of transpleural systemic artery to pulmonary vessel fistulas are detailed. Given the atypical imaging appearance of these lesions, there is risk of misdiagnosis of these entities as a pulmonary arteriovenous malformation. Understanding the pathophysiology, complex anatomy, and treatment for these rare vascular malformations is crucial prior to angiographic intervention in order to improve outcomes, avoid misdiagnosis, and prevent inappropriate intervention.

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Bronchial and Nonbronchial Systemic Artery Embolization in Management of Hemoptysis: Experience with 348 Patients

ISRN Vascular Medicine ◽

10.1155/2013/263259 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Gamal M. Agmy ◽

Safaa M. Wafy ◽

Sherif A. A. Mohamed ◽

Yaser A. Gad ◽

Hisham Mustafa ◽

...

Keyword(s):

Bronchial Artery ◽

University Hospital ◽

Artery Embolization ◽

Bronchial Arteries ◽

Vascular Abnormalities ◽

Systemic Artery ◽

Life Threatening ◽

Short And Long Term ◽

Systemic Arteries

Background. We aimed to report our experience with bronchial artery embolization (BAE) in the management of moderate recurrent and/or life-threatening hemoptysis. Methods. We evaluated the demographics, clinical presentation, radiographic studies, short- and long-term efficacy, and complications in patients Who underwent BAE, at a tertiary university hospital, from 2003 to 2012. Results. Three hundred forty-one patients underwent BAE for the management of moderate recurrent or life-threatening hemoptysis. Pulmonary TB and bronchiectasis were the most common etiologies for hemoptysis in our locality. The most common angiographic signs for hemoptysis were hypervascularity and systemic-pulmonary artery shunt. BAE was successful in controlling hemoptysis immediately in 95% of patients and at 1 month in 90% of patients. Recurrence of hemoptysis was observed in 9.6% of patients, and reembolization was indicated in 85% of those cases. Complications of BAE were self-limited acute and subacute complications, while chronic complications were not recorded during this study. Conclusions. TB and bronchiectasis are the commonest etiologies for moderate recurrent or life-threatening hemoptysis in our locality. Hypervascular lesions from the bronchial arteries and nonbronchial systemic arteries represented the major vascular abnormalities. Bronchial and nonbronchial systemic artery embolizations were effective to control both acute and chronic hemoptyses, with no serious complications.

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Transcatheter Embolization of Systemic-to-pulmonary Artery Fistulas: a Case Report

10.21203/rs.3.rs-1004874/v1 ◽

2021 ◽

Author(s):

Shen Zhang ◽

Jun Qian

Keyword(s):

Pulmonary Artery ◽

Arterial Embolization ◽

Lung Parenchyma ◽

Transcatheter Embolization ◽

Bronchial Arteries ◽

Pulmonary Vessel ◽

Inferior Phrenic Artery ◽

Systemic Artery ◽

Phrenic Artery ◽

Pulmonary Artery Fistula

Abstract The systemic artery to pulmonary vessel fistula(SAPVF) is an uncommon vascular abnormal communication between systemic arteries (except bronchial arteries) and the lung parenchyma[1]. It can be divided into congenital and acquired causes. Congenital SAPVF is often accompanied by cardiac or pulmonary artery hypoplasia, and acquired are usually caused by pleural adhesions after pleurisy, empyema, trauma, or surgery[2].We report a case of transcatheter arterial embolization for the treatment of congenital right inferior phrenic artery to pulmonary artery fistula.

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Endothelial vasodilator production by uterine and systemic arteries. II. Pregnancy effects on NO synthase expression

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1997.272.4.h1730 ◽

1997 ◽

Vol 272 (4) ◽

pp. H1730-H1740 ◽

Cited By ~ 35

Author(s):

R. R. Magness ◽

C. E. Shaw ◽

T. M. Phernetton ◽

J. Zheng ◽

I. M. Bird

Keyword(s):

Specific Activity ◽

No Synthase ◽

No Production ◽

Tetraacetic Acid ◽

Cgmp Production ◽

Western Analysis ◽

Systemic Artery ◽

Pregnant Sheep ◽

Oxide Synthase ◽

Systemic Arteries

Pregnancy is characterized by elevations in uterine but not omental artery nitric oxide synthase (NOS)-specific activity. We hypothesized that increases in NO production during pregnancy are associated with elevations in protein expression of the constitutive isoform, endothelial cell NOS (ecNOS), in uterine but not systemic arteries. Arterial NOS-specific activity and guanosine 3',5'-cyclic monophosphate (cGMP) production were tested in pregnant sheep in the presence or absence [+5 mM ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid] of Ca2+. With the use of Western analysis, ecNOS and neuronal NOS (nNOS) constitutive isoform expressions were evaluated in intact and denuded [vascular smooth muscle (VSM)] uterine and systemic (omental and renal) arteries as well as in isolated endothelium-derived proteins from nonpregnant and pregnant sheep. Uterine and omental artery NOS activity and cGMP production were inhibited 75-85% by Ca2+ removal. ecNOS was localized only in uterine and systemic artery endothelium (not VSM) by immunohistochemistry and Western analysis; nNOS was not detected. Compared with nonpregnant ewes, pregnancy increased expression of ecNOS in uterine [2.1- to 4.2-fold (P < 0.0001)] and omental [1.3- to 2.2-fold (P = 0.032)] but not renal (P = 0.1367) artery endothelium. Increases in uterine were greater than in omental artery endothelium. Levels of plasma and urinary cGMP were elevated (P < 0.01) proportionally (1.8- to 2.0-fold) in pregnant versus nonpregnant ewes. During pregnancy, expression of uterine artery endothelium-derived (not VSM) ecNOS constitutive isoform is increased, whereas expression in systemic vessels shows little or no change.

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Multidetector computed tomography angiography prior to bronchial artery embolization helps detect culprit ectopic bronchial arteries and non-bronchial systemic arteries originating from subclavian and internal mammary arteries and improve hemoptysis-free early survival rate in patients with hemoptysis

European Radiology ◽

10.1007/s00330-018-5767-6 ◽

2018 ◽

Vol 29 (4) ◽

pp. 1950-1958 ◽

Cited By ~ 4

Author(s):

Pei-Jun Li ◽

He Yu ◽

Ye Wang ◽

Fa-Ming Jiang ◽

Wei Wang ◽

...

Keyword(s):

Computed Tomography ◽

Survival Rate ◽

Bronchial Artery ◽

Bronchial Artery Embolization ◽

Artery Embolization ◽

Bronchial Arteries ◽

Mammary Arteries ◽

Internal Mammary ◽

Systemic Arteries ◽

Multidetector Computed Tomography Angiography

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Management of Low-Flow Vascular Malformations: Clinical Presentation, Classification, Patient Selection, Imaging and Treatment

CardioVascular and Interventional Radiology ◽

10.1007/s00270-015-1085-4 ◽

2015 ◽

Vol 38 (5) ◽

pp. 1082-1104 ◽

Cited By ~ 20

Author(s):

Ian McCafferty

Keyword(s):

Patient Selection ◽

Clinical Presentation ◽

Vascular Malformations ◽

Low Flow

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Spinal artery aneurysms: clinical presentation, radiological findings and outcome

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013687 ◽

2018 ◽

Vol 10 (7) ◽

pp. 644-648 ◽

Cited By ~ 3

Author(s):

Leonardo Renieri ◽

Eytan Raz ◽

Giuseppe Lanzino ◽

Timo Krings ◽

Maksim Shapiro ◽

...

Keyword(s):

Back Pain ◽

Retrospective Review ◽

Clinical Presentation ◽

Treated Patient ◽

Demographic Data ◽

Treatment Options ◽

Treatment Strategies ◽

Imaging Characteristics ◽

Arterial Aneurysms

Background and purposeSpinal arterial aneurysms are a rare cause of spinal subarachnoid hemorrhage (SAH). We performed a retrospective review of spinal arterial aneurysms not associated with spinal arteriovenus shunts from three institutions in order to better understand the clinical and imaging characteristics of these lesions.Materials and methodsWe performed a retrospective review of spinal arterial aneurysms managed at three North American institutions. For each patient, the following information was collected: demographic data, clinical presentation, comorbidities, imaging findings, and neurological status at the last follow-up. Treatment strategies and outcomes were reported.Results11 patients were included; 7 were women and median age was 60 years. The most common presentation was sudden back pain (81.8%). We found 3 aneurysms on the radiculomedullary artery and 8 along the radiculopial arteries. Of the 3 aneurysms on the radiculomedullary artery, 1 was treated conservatively, 1 was treated with coiling of the aneurysm and sacrifice of the radiculomedullary artery, and 1 was treated with surgical trapping. The 8 aneurysms on the radiculopial artery were treated endovascularly in 4 cases, surgically in 1 case, and conservatively in 3 cases. One surgically treated patient had a spinal subdural hematoma. There were no other complications. Mean clinical follow-up time was 20 months, and 87.5% of patients were functionally independent.ConclusionsSpinal arterial aneurysms are lesions which commonly present with sudden back pain and spinal SAH. Conservative, surgical, and endovascular treatment options are safe and effective. Long term outcomes in these patients are generally good.

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Clinical and angioarchitectural characteristics of spinal vascular malformations of the cervical spine

Journal of Neurosurgery Spine ◽

10.3171/2019.11.spine19798 ◽

2020 ◽

Vol 32 (5) ◽

pp. 755-762 ◽

Cited By ~ 1

Author(s):

Waleed Brinjikji ◽

Elisa Colombo ◽

Giuseppe Lanzino

Keyword(s):

Cervical Spine ◽

Lower Extremity ◽

Clinical Presentation ◽

Vascular Malformations ◽

Case Series ◽

Acute Onset ◽

Lower Extremity Weakness ◽

Arteriovenous Fistulas ◽

Spinal Vascular Malformations ◽

Interventional Neuroradiologist

OBJECTIVEVascular malformations of the cervical spine are exceedingly rare. To date there have been no large case series describing the clinical presentation and angioarchitectural characteristics of cervical spine vascular malformations. The authors report their institutional case series on cervical spine vascular malformations diagnosed and treated at their institution.METHODSThe authors retrospectively reviewed all patients with spinal vascular malformations from their institution from January 2001 to December 2018. Patients with vascular malformations of the cervical spine were included. Lesions were characterized by their angioarchitectural characteristics by an interventional neuroradiologist and endovascular neurosurgeon. Data were collected on clinical presentation, imaging findings, treatment outcomes, and long-term follow-up. Descriptive statistics are reported.RESULTSOf a total of 213 patients with spinal vascular malformations, 27 (12.7%) had vascular malformations in the cervical spine. The mean patient age was 46.1 ± 21.9 years and 16 (59.3%) were male. The most common presentations were lower-extremity weakness (13 patients, 48.1%), tetraparesis (8 patients, 29.6%), and lower-extremity sensory dysfunction (7 patients, 25.9%). Nine patients (33.3%) presented with hemorrhage. Fifteen patients (55.6%) had modified Rankin Scale scores of 0–2 at the time of diagnosis. Regarding angioarchitectural characteristics, 8 patients (29.6%) had intramedullary arteriovenous malformations (AVMs), 5 (18.5%) had epidural arteriovenous fistulas (AVFs), 4 (14.8%) had paraspinal fistulas, 4 (14.8%) had mixed epidural/intradural fistulas, 3 (11.1%) had perimedullary AVMs, 2 (7.4%) had dural fistulas, and 1 patient (3.7%) had a perimedullary AVF.CONCLUSIONSThis retrospective study of 27 patients with cervical spine vascular malformations is the largest series to date on these lesions. The authors found substantial angioarchitectural heterogeneity with the most common types being intramedullary AVMs followed by epidural AVFs, paraspinal fistulas, and mixed intradural/extradural fistulas. Angioarchitecture dictated the clinical presentation as intradural shunts were more likely to present with hemorrhage and acute onset myelopathy, while dural and extradural shunts presented as either incidental lesions or gradually progressive congestive myelopathy.

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Pulmonary vessel casting in a rat model of monocrotaline-mediated pulmonary hypertension

Pulmonary Circulation ◽

10.1177/2045894020922129 ◽

2020 ◽

Vol 10 (3) ◽

pp. 204589402092212

Author(s):

Zhongkai Zhu ◽

Yifan Wang ◽

Amy Long ◽

Tianyu Feng ◽

Maria Ocampo ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Rat Model ◽

Vascular System ◽

Pulmonary Arteries ◽

Pulmonary Vasculature ◽

Control Group ◽

Wall Thickening ◽

Arterial Remodeling ◽

Pulmonary Vessel ◽

Pulmonary Arterial

Pulmonary hypertension is a chronic vascular disease characterized by pulmonary vasoconstriction and pulmonary arterial remodeling. Pulmonary arterial remodeling is mainly due to small pulmonary arterial wall thickening and lumen occlusion. Previous studies have described intravascular changes in lung sections using histopathology, but few were able to obtain a fine detailed image of the pulmonary vascular system. In this study, we used Microfil compounds to cast the pulmonary arteries in a rat model of monocrotaline-induced pulmonary hypertension. High-quality images that enabled quantification of distal pulmonary arterial branching based on the number of vessel bifurcations/junctions were demonstrated in this model. The branch and junction counts of distal pulmonary arteries significantly decreased in the monocrotaline group compared to the control group, and this effect was inversely proportional to the mean pulmonary artery pressure observed in each group. The patterns of pulmonary vasculature and the methods for pulmonary vessel casting are presented to provide a basis for future studies of pulmonary arterial remodeling due to pulmonary hypertension and other lung diseases that involve the remodeling of vasculature.

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Imaging of Mixed and Radiopaque Jaw Lesions

Seminars in Musculoskeletal Radiology ◽

10.1055/s-0039-3402766 ◽

2020 ◽

Vol 24 (05) ◽

pp. 558-569

Author(s):

Filip M. Vanhoenacker ◽

Frederik Bosmans ◽

Charlotte Vanhoenacker ◽

Anja Bernaerts

Keyword(s):

Computed Tomography ◽

Bone Tumors ◽

Developmental Disorders ◽

Clinical Presentation ◽

Bone Diseases ◽

Cone Beam ◽

Panoramic Radiographs ◽

Primary Bone Tumors ◽

Imaging Characteristics ◽

Primary Bone

AbstractRadiopaque lesions and lesions of mixed density are less frequent than radiolucent lesions of the jawbones. They comprise a spectrum of odontogenic and non-odontogenic lesions. The latter group includes inherited and developmental disorders, osteomyelitis, and benign and malignant primary bone tumors and metastases. Most odontogenic radiopaque or mixed lesions are either related to the apex or more rarely to the crown of the tooth, although there are exceptions to this rule. Some lesions, such as a torus mandibularis and torus palatinus, have a characteristic location, whereas others show no relationship to the dentition. This article describes the most characteristic and prevalent radiopaque and mixed lesions of the jaws and their imaging characteristics. Paget's disease, fibrous dysplasia, and rare sclerotic bone diseases of the maxillofacial bones are discussed elsewhere in this issue. Careful correlation of clinical presentation, panoramic radiographs, cone beam computed tomography, and histopathology are the cornerstones for appropriate lesion characterization.

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