151
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Thierrien J, Gerlis LM, Kilner P, Somerville J. Complex pulmonary atresia in an adult: natural history, unusual pathology and mode of death. Cardiol Young 1999; 9:249-56. [PMID: 10386693 DOI: 10.1017/s104795110000490x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A patient with unrepaired complex pulmonary atresia had a normal life, achieving two successful pregnancies, until the age of 44 years. Confluent central pulmonary arteries were supplied by a fistuious communication from the left coronary artery, and from other collateral arteries arising from the underside of the aortic arch. Unusual aneurysms were present. Death at the age of 46 resulted from dissection and rupture of an aneurysmal dilation of the pulmonary trunk.
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Affiliation(s)
- J Thierrien
- Jane Somerville Grown Up Congenital Heart Unit, National Heart and Lung Institute, Imperial College School of Medicine, and the Royal Brompton Hospital, London, UK
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152
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153
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Basoglu T, Canbaz F, Bernay I, Danaci M. Bilateral pulmonary artery aneurysms in a patient with Behcet syndrome: evaluation with radionuclide angiography and V/Q lung scanning. Clin Nucl Med 1998; 23:735-8. [PMID: 9814558 DOI: 10.1097/00003072-199811000-00002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The case of a 14-year-old girl with Behcet syndrome is described. Besides painful and recurrent oral ulcerations, the patient had a cough and intermittent hemoptysis. The initial chest roentgenogram revealed bilateral parahilar opacities. CT and MRI scans of the thorax showed bilateral thrombosing aneurysms of the pulmonary arteries. Pulmonary blood flow imaging was performed after technegas ventilation lung scanning and Tc-99m MAA injection using a first-pass radionuclide angiography procedure. Altered blood flow in the left pulmonary artery was shown. Bilateral and well-defined ventilation/perfusion mismatched areas suggested a high probability of pulmonary embolism. Little additional information was obtained on subsequent contrast pulmonary angiography. The high incidence of pulmonary artery hypertension and associated vascular injury risk makes pulmonary angiography an unsafe procedure in patients with pulmonary Behcet syndrome. The need for pulmonary angiography could be obviated in such cases with the use of high-precision MRI and ventilation/perfusion lung scanning, including radionuclide pulmonary angiography.
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Affiliation(s)
- T Basoglu
- Department of Nuclear Medicine, Ondokuz Mayis University Hospital, Samsun, Turkey
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154
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Wekerle T, Klepetko W, Taghavi S, Birsan T. Lung transplantation for primary pulmonary hypertension and giant pulmonary artery aneurysm. Ann Thorac Surg 1998; 65:825-7. [PMID: 9527223 DOI: 10.1016/s0003-4975(97)01413-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report the case of an 18-year-old patient with a giant pulmonary artery aneurysm and primary pulmonary hypertension who was successfully treated with bilateral lung transplantation and complete reconstruction of the pulmonary artery.
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Affiliation(s)
- T Wekerle
- Department of Cardiothoracic Surgery, University of Vienna, Vienna General Hospital, Austria
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155
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Abstract
Aneurysm of the main pulmonary artery is an extremely rare entity. The first successful repair of an aneurysm of the main pulmonary artery was reported in 1971. Since then, surgical correction of the aneurysm of main pulmonary artery has been undertaken in only 6 cases. A thorough survey of the literature, including autopsy cases, medical cases, and surgical cases, shows the aneurysm in the present case to be one of the largest.
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Affiliation(s)
- Y F Chen
- Department of Surgery, Kaohsiung Medical College, Taiwan
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156
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Affiliation(s)
- K G Chetty
- Department of Medicine, VA Medical Center, Long Beach, California 90822-5201, USA
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157
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DeBoer DA, Margolis ML, Livornese D, Bell KA, Livolsi VA, Bavaria JE. Pulmonary venous aneurysm presenting as a middle mediastinal mass. Ann Thorac Surg 1996; 61:1261-2. [PMID: 8607703 DOI: 10.1016/0003-4975(95)00980-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A large mediastinal mass in a 43-year-old man was proven at thoracotomy to comprise a right superior pulmonary vein aneurysm. Intraoperative transesophageal echocardiography was useful in defining the abnormality. Pulmonary venous aneurysm appears to represent an extremely rare but surgically correctable addition to the differential diagnosis of middle mediastinal masses.
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Affiliation(s)
- D A DeBoer
- Department of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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158
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Onorato E, Festa P, Bourlon F, Yves L, Ballerini L. Idiopathic right pulmonary artery aneurysm with pulmonary valve insufficiency. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1996; 37:162-5. [PMID: 8808073 DOI: 10.1002/(sici)1097-0304(199602)37:2<162::aid-ccd12>3.0.co;2-m] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A case of idiopathic right pulmonary artery aneurysm with pulmonary valve insufficiency simulating a mediastinal teratoma occurred in an asymptomatic 13-year-old boy. The key to correct diagnosis was pulmonary angiography. The patient was successfully treated with surgery.
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Affiliation(s)
- E Onorato
- Centro Cardiovascolare E. Malan, Ospedale Clinicizzato San Donato, San Donato Milanese, Italy
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159
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Lopez-Candales A, Kleiger RE, Aleman-Gomez J, Kouchoukos NT, Botney MD. Pulmonary artery aneurysm: review and case report. Clin Cardiol 1995; 18:738-40. [PMID: 8608676 DOI: 10.1002/clc.4960181211] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Aneurysms involving the main pulmonary artery and its branches are rare. Clinical experience is limited and current knowledge is mainly derived from autopsy findings. This case report describes a patient with a pulmonary artery aneurysm associated with a previous, partially corrected stenotic pulmonary valve. The patient presented with symptoms suggestive of aneurysm dissection three decades after commissurotomy. The diagnostic approach and therapeutic intervention are emphasized with a review of the literature.
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Affiliation(s)
- A Lopez-Candales
- Division of Cardiology, Jewish Hospital of St. Louis, Washington University Medical Center, Missouri 63110, USA
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160
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Abstract
We present a case of left pulmonary artery aneurysm with pulmonary valve stenosis. The aneurysm was excluded and the valve replaced by the implantation of a pulmonary artery allograft. The short-term follow-up (20 months) is promising.
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Affiliation(s)
- F Casselman
- Department of Cardiovascular and Thoracic Surgery, Imeldaziekenhuis Imeldalaan, Bonheiden, Belgium
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161
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Chung CW, Doherty JU, Kotler R, Finkelstein A, Dresdale A. Pulmonary artery aneurysm presenting as a lung mass. Chest 1995; 108:1164-6. [PMID: 7555134 DOI: 10.1378/chest.108.4.1164] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We describe a case of pulmonary artery aneurysm in which clinical clues and conventional imaging suggested a lung tumor, and the actual nature of the lesion was discovered at the time of thoracotomy. This case shows the importance of an awareness of this condition in the formulation of a differential diagnosis for a lung mass.
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Affiliation(s)
- C W Chung
- University of Pennsylvania School of Medicine, Philadelphia, USA
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162
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Grahmann PR, Bonnet R, Swoboda L, Nöldge G, Hasse J. Pulmonary arteriovenous malformations. Case reports and literature review. Angiology 1994; 45:399-404. [PMID: 8172388 DOI: 10.1177/000331979404500510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Pulmonary arteriovenous malformations (PAVM) represent an uncommon disease with only 500 reported cases. To emphasize the resectional surgical standard, 2 patients with PAVM and pulmonary right-to-left shunt are presented and the optional treatments discussed. One patient had suffered from a cerebrovascular accident. The other patient's diagnosis resulted from a coincidental finding in connection with an unrelated illness. Because of the risk of acutely developing complications, especially disabling or fatal cerebral ischemia, therapy is generally recommended even in asymptomatic patients. The 2 patients presented here were treated by resection. Surgical treatment with a very low risk and parenchyma-sparing technique remains the golden standard for large isolated malformations. In addition to the established and reliable operative therapy, since 1978 catheter embolization is becoming the method of choice with an increasing range of indications in those centers experienced with this technique.
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Affiliation(s)
- P R Grahmann
- Abteilung Lungenchirurgie/Chirurgische Universitätsklinik, Klinikum der Albert-Ludwigs-Universität Freiburg, Germany
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163
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164
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Uh S, Kim JO, You YK, Moon SH, Park CS. A case of Behçet's disease combined with pulmonary artery aneurysm in a Korean female patient. Korean J Intern Med 1994; 9:47-50. [PMID: 8038147 PMCID: PMC4532054 DOI: 10.3904/kjim.1994.9.1.47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Behçet's disease (BD) is a systemic disorder of unknown process resulting from systemic vasculitis. The pulmonary involvements in BD are uncommon. Furthermore, in the female, involvement of the pulmonary artery is quite rare. There were a few cases of female patients with BD with pulmonary artery aneurysm confirmed by pulmonary artery angiogram. In this article, we report a case of BD, combined with pulmonary artery aneurysm, confirmed by pulmonary angiogram and treated by surgery in a Korean female patient.
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Affiliation(s)
- S Uh
- Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
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165
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Abstract
Between August 1983 and January 1991, seven patients with Marfan syndrome underwent surgery for severe cardiovascular complications. The mean age at presentation was 5.7 months (range 4 to 9 months) in the infant group (n = 3), and 13.3 years (range 10 to 16 years) in a group of older children (n = 4). The primary indications for surgery in the infant group (performed at a mean of 3 years after diagnosis) were ascending aortic aneurysm with valvar regurgitation in one patient, and severe mitral valve prolapse with regurgitation in two. In the older group, surgical indications (performed at a mean of 2.8 years after diagnosis) were ascending aortic aneurysm with valvar regurgitation in three patients and acute aortic dissection in one. For aortic surgery, a composite valved conduit was used in four patients, and an aortic homograft in one. For mitral valve surgery, mechanical prostheses were used. All patients survived the primary operation. Over a mean follow-up of 17.5 patient-years (range 1 to 9 years), two patients in the infant Marfan group went on to further successful surgery (prosthetic mitral valve replacement and aortic root repair with aortic homograft) at a mean interval of 4.3 years after the initial surgery. Our results suggest that the major cardiovascular risk factors of Marfan syndrome in the young, even in those diagnosed during infancy, have been favorably changed by surgery with an encouraging medium-term outlook. The correct timing of surgery is aided by echocardiography.
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Affiliation(s)
- V T Tsang
- Royal Children's Hospital, Melbourne, Australia
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166
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Fields CL, Roy TM, Ossorio MA. Thrombosed pulmonary artery aneurysm. A rare cause of a high-probability lung scan. Chest 1992; 102:1292-4. [PMID: 1395791 DOI: 10.1378/chest.102.4.1292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The high-probability ventilation-perfusion lung scan is accepted as supportive of pulmonary embolism and often negates further diagnostic evaluation; however, there are processes that mimic the clinical presentation and radiographic findings of pulmonary emboli, including a unilateral segmental or greater perfusion defect. We present the findings in a patient whose presentation and ventilation-perfusion scans over a three-month course were suggestive of pulmonary embolism, yet pulmonary angiography revealed a thrombosed pulmonary artery aneurysm. The interpretation of a unilateral segmental perfusion defect as high probability does not secure the diagnosis of pulmonary embolism and should not preclude further evaluation for alternative etiologies.
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Affiliation(s)
- C L Fields
- Department of Respiratory and Environmental Medicine, University of Louisville School of Medicine
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167
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Girgis R, Kavuru MS, Miller M, Spizarny D. Bilateral proximal pulmonary artery aneurysms simulating hilar adenopathy. Chest 1992; 102:311-3. [PMID: 1623780 DOI: 10.1378/chest.102.1.311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Proximal pulmonary artery aneurysms (PAAs) are rare. Most are associated with secondary pulmonary hypertension or a variety of rare systemic disorders. An asymptomatic adult patient presented with bilateral hilar enlargement on a routine chest roentgenogram. Computed tomography of the chest revealed 5 cm bilateral proximal PAAs with a normal pulmonary trunk. The clinician should consider proximal PAA in the differential diagnosis of hilar enlargement.
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Affiliation(s)
- R Girgis
- Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit
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168
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Hirata K, Triposkiadis F, Sparks E, Bowen J, Boudoulas H, Wooley CF. The Marfan syndrome: cardiovascular physical findings and diagnostic correlates. Am Heart J 1992; 123:743-52. [PMID: 1539526 DOI: 10.1016/0002-8703(92)90515-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Correlations among cardiac symptoms and auscultatory and phonoechocardiographic findings in Marfan syndrome have not been completely defined. A total of 24 patients with Marfan syndrome (16 men and 8 women; mean age 28.2 +/- 8.6 years) were studied. Mitral valve prolapse was noted in 22, of whom 19 had either nonejection systolic click or mitral regurgitation murmur. Mitral regurgitation was noted in 12 patients by Doppler imaging. Aortic root dilatation was noted in 20 patients and aortic regurgitation in six, five of whom had aortic regurgitation murmur (5 of 20 patients had undergone surgery). Proximal aortic dissection was noted in two. Dyspnea (n = 12) was associated with progressive mitral or aortic regurgitation in four, but in the others dyspnea could not be explained by valvular or ventricular abnormalities. Chest pain was related to pneumothorax in five and aortic dissection in two but was not associated with either in 15 patients. Palpitations (n = 12) and lightheadedness (n = 6) were not associated with specific arrhythmias. In conclusion, mitral valve prolapse and aortic root dilatation were the most common cardiovascular abnormalities in Marfan syndrome. Mitral valve prolapse was frequently associated with typical auscultatory findings and symptoms including dyspnea, chest pain, palpitations, and lightheadedness, whereas aortic root dilatation could be clinically silent unless complicated by aortic regurgitation or aortic dissection.
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Affiliation(s)
- K Hirata
- Division of Cardiology, Ohio State University, Columbus
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169
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Steurer J, Jenni R, Medici TC, Vollrath T, Hess OM, Siegenthaler W. Dissecting aneurysm of the pulmonary artery with pulmonary hypertension. THE AMERICAN REVIEW OF RESPIRATORY DISEASE 1990; 142:1219-21. [PMID: 2240847 DOI: 10.1164/ajrccm/142.5.1219] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pulmonary artery dissection was observed in a 64-yr-old female patient with severe pulmonary hypertension, which was probably primary (pulmonary vascular resistance, 817 dyn.s.cm-5; normal range less than or equal to 200 dyn.s.cm-5). The patient was admitted to the hospital because of severe dyspnea on exertion. Echocardiography demonstrated a dissecting aneurysm of the pulmonary artery. Right heart catheterization revealed severe pulmonary hypertension (mean pulmonary artery pressure, 64 mm Hg; normal range, 10 to 22 mm Hg); dissection of the pulmonary artery was confirmed by pulmonary arteriography. One-year follow-up was uneventful. In the literature, 28 patients with dissecting aneurysm of the pulmonary artery are reviewed. The dissection has only been diagnosed in life in one patient (by echocardiography).
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Affiliation(s)
- J Steurer
- Department of Medicine, University Hospital, Zürich, Switzerland
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170
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 16-1990. A 57-year-old woman with a thalamic lesion and pulmonary arteriovenous fistulas. N Engl J Med 1990; 322:1139-48. [PMID: 2320081 DOI: 10.1056/nejm199004193221608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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