Absence of Right Pulmonary Artery With Pulmonary Valve Stenosis and Partial Connection of Descending Aorta：A Case Report

Background:Unilateral absence of pulmonary artery is a rare congenital disorder that can remain asymptomatic until adulthood. Absence of right pulmonary artery (ARPA) has been reported in two-thirds of this patient population.It may be isolated, but it is more often associated with other congenital cardiac defects such as aortic coarctation, tetralogy of Fallot, atrial septal defect and patent ductus arteriosus.Case presentation: We are the first to introduce an adult case of ARPA with pulmonary valve stenosis（PVS） and associated with partial connection of descending aorta.We investigated the condition by right heart catheterization,right ventricle angiography, pulmonary arteriography and aorta angiography. According to the above results，we suggest that surgical treatment should be positively consideredConclusions: The case remind that echocardiography combined with detailed imaging examination is very important for the diagnosis of complex congenital heart disease and provide the basis for the selection of the best treatment.

Sequelae Tuberkulosis dengan Hemoptisis Rekurens

Background: Various sequelae and complications can occur in treated or untreated tuberculosis (TB). One of complications in the lungs is hemoptysis, due to alterations of pulmonary vascular structure. Hemoptysis as TB sequelae can happen recurrently and massively. Case: We present the case of 31 year old man with recurrent hemoptysis since 1 year before admitted to hospital. Patient had a history of receiving antituberculosis drugs (ATD) before. Chest xray showed pleural thickening and opacity in right hemithorax with signs of loss of volume. Bronchoscopy showed active bleeding in lateral segment of right lung middle lobe. Chest CT showed destroyed right lung. Hemoptysis still existed despite the given conventional therapy, thus patient underwent pulmonary arteriography. The result showed extensive vascular abnormality in the right lung with arteriovenous fistula on right bronchial artery and aneurysmatic branch of superior bronchial and inner intercostal arteries. During the procedure, there was no active bleeding, so bronchial artery embolization was adjourned. Patient then experienced recurrent and massive hemoptysis, thus right pneumonectomy was done. During the surgery, there was uncontrolled active bleeding that caused the patient’s death. Conclusion: This case illustrates recurrent hemoptysis as one of severe TB sequelae. In extensive pulmonary vascular abnormality, pneumonectomy can cause uncontrolled active bleeding. Bronchial artery embolization can be used as an alternative to treat patients with recurrent homptysis.

Where is the Origin of the Last Normal Branch from Feeding Artery of Pulmonary Arteriovenous Malformations?

Purpose Reperfusion via pulmonary-to-pulmonary arterial anastomoses is known as one type of recurrence of pulmonary arteriovenous malformations (PAVMs) after embolization. It is important to occlude the fistulous portion beyond the origin of the last normal branch from feeding artery of PAVMs to prevent recurrence. In this study, we evaluate the origin of the last normal branch by CT as well as its visibility on pulmonary arteriography (PAG). Materials and Methods We reviewed forty patients with 77 PAVMs who underwent coil embolization between October 2007 and December 2017. All patients underwent MDCT before embolization. Axial and MPR CT lung images were reviewed with special interests in the origin of the last normal branch from feeding artery of PAVMs. The origin was classified into three portions, including sac, junction (portion just proximal to the sac) and proximal feeder (more than 5 mm proximal to the sac). We also evaluated whether PAG can depict the normal branches detected by MDCT. Results MDCT showed that the last normal branch originated from sac in 30 PAVMs (39.0%), junction in 39 (50.6%), and proximal feeder in 8 (10.4%).On selective PAG, the last normal branch could be visualized in 30 PAVMs (39.0%), although it could not be visualized due to high-flow shunt in the other 47 PAVMs. Conclusions Selective PAG frequently fails to demonstrate the last normal branch from feeding artery of PAVMs, which often originates from the sac. Pretherapeutic evaluation of CT images of the last normal branch is important to prevent reperfusion of PAVMs. Level of Evidence Level 3, local non-random sample.

Optimal Technique for Catheterizing the Pulmonary Arteries Without Dedicated Pulmonary Catheters

With the emergence of high-resolution computed tomography angiography, the number of transcatheter pulmonary arteriograms being performed has steeply declined. For this reason, many interventional departments no longer stock dedicated pulmonary artery catheters such as the pre-shaped 7 Fr Grollman catheter for a femoral vein approach. Interventionalists are therefore required to improvise with catheters that are available on hand. Transcatheter pulmonary arteriography may be indicated when dedicated pulmonary artery catheters are not available for use. In this chapter, a step-by-step approach is described and accompanied by illustrations demonstrating how a common diagnostic catheter, the 5 Fr Omniflush catheter, can be used to perform pulmonary arteriography.

Frequency of Nonthromboembolic Imaging Abnormalities in Pregnant Women Referred for Computed Tomography Pulmonary Arteriography

Purpose The study sought to determine the frequency of nonthromboembolic imaging abnormalities in pregnant women referred for computed tomography pulmonary arteriography (CTPA). Materials and Methods CTPA studies on 100 consecutive pregnant women performed over a 5-year period were reviewed independently by 2 radiologists, with conflicts resolved by consensus. Age range was 18-43 years (mean 28 years). The presence or absence of pulmonary embolism and of nonthromboembolic imaging abnormalities was recorded. These were graded as A if the abnormalities were thought to provide potential alternative explanations for acute symptoms, B if findings were incidental that required clinical or radiologic follow-up, and C if the findings did not require further action. Results Pulmonary embolism was seen in 5 women. In 2 of these additional findings of consolidation and infarction were seen. Ninety-five women did not have pulmonary embolism. Eleven women (12%) had grade A abnormalities; 6 cases of consolidation, 2 cases of lobar collapse, and 3 cases of heart failure with pleural effusions. One woman had a grade B abnormality due to the presence of pulmonary nodules. Ten women had incidental grade C abnormalities. Conclusion Pulmonary embolism occurs in 5% of pregnant women referred for CTPA. In pregnant women without embolism on CTPA, potential alternative causes for patient symptoms are seen on CT in 12% of cases.