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Notsuda H, Tomiyama F, Onodera K, Watanabe T, Watanabe Y, Oishi H, Niikawa H, Inoue C, Ota H, Noda M, Okada Y. Systemic-to-pulmonary artery shunt treated with transcatheter arterial embolization and subsequent lung segmentectomy. Egypt Heart J 2023; 75:103. [PMID: 38123754 PMCID: PMC10733262 DOI: 10.1186/s43044-023-00431-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Systemic-to-pulmonary artery shunt (SPAS) is a rare condition that can occur as a result of congenital heart disease or chronic pulmonary inflammation, occasionally leading to life-threatening hemoptysis. Computed tomography (CT) imaging is crucial in the diagnosis of SPAS, and the optimal management approach for SPAS remains uncertain. This case report presents a novel approach to the treatment of SPAS, consisting of transcatheter arterial embolization of the systemic artery followed by lung segmentectomy. CASE PRESENTATION A 42-year-old man with abnormal chest findings was referred to us and a diagnosis of SPAS was established based on the CT findings showing a blood flow regurgitation from the dilated left 4th intercostal artery to the Lt. A6. The patient was asymptomatic but we decided to treat him to prevent a risk of future hemoptysis. Transcatheter arterial embolization (TAE) of systemic arteries followed by S6 segmentectomy was successfully performed with minimal blood loss and complete removal of the dilated intra-pulmonary blood vessels. Histological analysis confirmed the diagnosis of SPAS. CONCLUSION We reported a case of SPAS, who was successfully treated with the combination of TAE and subsequent segmentectomy. The blood loss during surgery was minimal and this strategy appeared to minimize future recanalization and hemoptysis. Further studies and long-term follow-up of SPAS patients are required to establish standardized management guidelines for this rare condition.
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Affiliation(s)
- Hirotsugu Notsuda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Fumiko Tomiyama
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Ken Onodera
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuaki Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yui Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Hisashi Oishi
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Hiromichi Niikawa
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Chihiro Inoue
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Masafumi Noda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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Ishida Y, Yukawa T, Nagasaki Y, Minami D, Fujiwara H, Monobe Y, Fukazawa T, Yamatsuji T. A surgical case of pulmonary adenocarcinoma in the right upper lobe associated with a systemic artery-to-pulmonary artery fistula. Thorac Cancer 2023. [PMID: 37308179 PMCID: PMC10363778 DOI: 10.1111/1759-7714.14985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/14/2023] Open
Abstract
A 52-year-old female never-smoker with an abnormal shadow in the right lung detected on radiography was referred to our institution. Contrast-enhanced computed tomography revealed an irregular nodule in the upper lobe of the right lung, suggestive of a pulmonary vascular abnormality. Angiography revealed a direct communication between the right internal mammary artery (IMA) and the right upper lobe pulmonary artery branches, with dilated and tortuous vascular proliferation. As multiple branch arteries were seen flowing into the upper lobe from the IMA, transcatheter selective embolization of these vessels and right upper lobectomy by video-assisted thoracoscopic surgery were performed. Contrary to the clinical diagnosis, the pathological finding was a pulmonary adenocarcinoma of the right upper lobe. Additional lymph node dissection was performed later. We report an extremely rare and unprecedented case of pulmonary adenocarcinoma fed by the right IMA, with a literature review.
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Affiliation(s)
- Yuta Ishida
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
| | - Takuro Yukawa
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
| | - Yasunari Nagasaki
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Daisuke Minami
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Hiroyasu Fujiwara
- Department of Diagnostic and Therapeutic Radiology, Kawasaki Medical School, Okayama, Japan
| | - Yasumasa Monobe
- Department of Pathology 1, Kawasaki Medical School, Okayama, Japan
| | - Takuya Fukazawa
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
| | - Tomoki Yamatsuji
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
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3
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Matsudo K, Haratake N, Ono Y, Kohno M, Takenaka T, Yoshizumi T. Multiple systemic artery to pulmonary vessel fistulas (SAPVFs) completely resected by video-assisted thoracoscopic surgery: a case report. Surg Case Rep 2022; 8:184. [PMID: 36167860 PMCID: PMC9515267 DOI: 10.1186/s40792-022-01540-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Systemic artery to pulmonary vessel fistula (SAPVF) is an uncommon abnormal vascular communication between systemic arteries and the lung parenchyma. It has been reported that the appropriate treatment for SAPVF is embolization or surgical resection. However, in patients such as ours, who have many aberrant vessels or multiple lesions, surgery should be considered as the first-choice treatment. Case presentation This case report describes multiple SAPVFs and huge bullae at the apex of the left lung in a 43-year-old man that were resected completely with the video-assisted thoracoscopic surgery (VATS). The patient had an uneventful postoperative recovery without any complications and was discharged 9 days postoperatively. He had heavy smoking history, and the giant bullae and the diffuse emphysematous change were found in the lung. Therefore, the chronic inflammation may have been present in the thoracic cavity, which caused multiple SAPVFs. Conclusions We describe the clinical course and management of the patient with multiple SAPVFs who had no obvious history of surgery, trauma, or various inflammatory or infection diseases. VATS should be the first-choice treatment in patients with many abnormal vessels or multiple lesions.
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Cheng X, Zhang X, Gu F, Tian C, Wang R, Chen J, Liu J, Zeng X. Multiple systemic arteries to pulmonary artery malformations: a case description. Quant Imaging Med Surg 2021; 11:4671-4675. [PMID: 34737933 DOI: 10.21037/qims-21-109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/23/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Xinge Cheng
- Department of Graduate School, Zunyi Medical University, Zunyi, China.,Department of Radiology, Guizhou Provincial People's Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
| | - Xiaoyong Zhang
- Department of Radiology, Guizhou Provincial People's Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
| | - Fujia Gu
- Department of Interventional Radiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Chong Tian
- Department of Radiology, Guizhou Provincial People's Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
| | - Rongpin Wang
- Department of Radiology, Guizhou Provincial People's Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
| | - Jiaxiang Chen
- Guizhou University School of Medicine, Guiyang, China
| | - Jian Liu
- Department of Graduate School, Zunyi Medical University, Zunyi, China.,Department of Radiology, Guizhou Provincial People's Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
| | - Xianchun Zeng
- Department of Radiology, Guizhou Provincial People's Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
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Gambuś K, Talar P, Kużdżał B, Urbańczyk M, Rudnicka L. Intrapulmonary arterio-venous fistula - unusual early complication of wedge resection. Ann Thorac Surg 2021; 113:e405-e407. [PMID: 34516962 DOI: 10.1016/j.athoracsur.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
We present a case of an arterio-venous fistula that developed in the early postoperative course after wedge resection of the right upper lobe. A 57-year old male treated for acute myeloid leukemia was referred from the hematology department because of a right upper lobe tumor. Wedge resection was performed. Three weeks later recurrent tumor was visualized on chest X-ray. Angio-CT diagnosed an arterio-venous fistula and the patient was scheduled for redo surgery. Completion upper lobectomy was performed and the pathological examination confirmed iatrogenic arterio-venous fistula. To our knowledge such an early complication has never been reported so far. Iatrogenic intrapulmonary arterio-venous fistulas are very rare. We present a case of such fistula that developed early after wedge resection of the right lung upper lobe tumor and presented as recurrent pulmonary mass. To the best of our knowledge this is the first description of such a case.
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Affiliation(s)
| | - Piotr Talar
- Department of Thoracic Surgery, John Paul II Hospital, Cracow, Poland
| | - Błażej Kużdżał
- Students Scientific Society Jagiellonian University Medical College, Cracow, Poland
| | | | - Lucyna Rudnicka
- Department of Pathology, John Paul II Hospital, Cracow, Poland
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Alsafi A, Shovlin CL, Jackson JE. Transpleural systemic artery-to-pulmonary artery communications in the absence of chronic inflammatory lung disease. A case series and review of the literature. Clin Radiol 2021; 76:711.e9-711.e15. [PMID: 33902886 DOI: 10.1016/j.crad.2021.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
AIM To describe the causes and computed tomography (CT) and angiographic appearances of transpleural systemic artery-to-pulmonary artery shunts in patients without chronic inflammatory lung disease and determine their best management. MATERIALS AND METHODS All patients referred to a tertiary referral unit between January 2009 and January 2020 in whom a diagnosis of a systemic-to-pulmonary artery communication without underlying chronic inflammatory lung disease was subsequently made have been included in this report. Medical records and imaging findings were reviewed retrospectively. RESULTS Ten patients (male: female ratio = 7:3; median age 42 years [range 22-70 years]) with systemic artery-to-pulmonary artery shunts without chronic inflammatory lung disease were identified. Five were misdiagnosed as having a pulmonary arteriovenous malformation and had been referred for embolisation. In six patients, there was either a history of accidental or iatrogenic thoracic trauma or of inflammatory disease involving the pleura, and in two patients, in whom a previous medical history could not be obtained, there were CT features suggesting previous pleural inflammatory disease. Two shunts were thought to be congenital. All individuals were asymptomatic other than one with localised thoracic discomfort that dated from the time of surgery. All patients were managed conservatively and have remained well with a median follow-up of 4.5 years (range 1-11.3 years). CONCLUSIONS Localised transpleural systemic artery-to-pulmonary artery shunts in the absence of chronic inflammatory lung disease are usually related to previous thoracic trauma/intervention or abdominal or pulmonary sepsis involving a pleural or diaphragmatic surface. Congenital shunts are rare. The present study and much of the literature supports conservative management.
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Affiliation(s)
- A Alsafi
- Imaging Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK.
| | - C L Shovlin
- Vascular Science, National Heart and Lung Institute, ICTEM, Imperial College London, London, UK; VASCERN HHT European Reference Centre and Respiratory Medicine, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK
| | - J E Jackson
- Imaging Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK
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Kermelly SB, Côté F, Maltais F. Pulmonary Artery Filling Defects: Beyond Pulmonary Embolism. Am J Respir Crit Care Med 2020; 201:e13-e14. [DOI: 10.1164/rccm.201901-0168im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - François Côté
- Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, Quebec, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec and
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8
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Jacheć W, Tomasik A, Kurzyna M, Pietura R, Torbicki A, Głowacki J, Nowalany-Kozielska E, Wojciechowska C. The multiple systemic artery to pulmonary artery fistulas resulting in severe irreversible pulmonary arterial hypertension in patient with previous history of pneumothorax. BMC Pulm Med 2019; 19:80. [PMID: 30991994 PMCID: PMC6469086 DOI: 10.1186/s12890-019-0832-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 03/13/2019] [Indexed: 11/28/2022] Open
Abstract
Background Systemic artery to pulmonary artery fistulas (SA-PAFs), are extremely rare in people without congenital heart disease. In this group of patients pulmonary arterial hypertension was reported in the single case. Then, we describe a case of multiple SA-PAFs, which were the cause of severe nonreversible arterial pulmonary hypertension in a patient who had a right-sided pneumothorax 35 years earlier. Case presentation 52-year-old male Caucasian patient with echocardiographically confirmed pulmonary hypertension (PH) was admitted to cardiology department due to exertional dyspnea and signs of right ventricle failure. Routine screening for causes of secondary PH was negative. Right heart catheterization (RHC) confirmed a high degree arterial PH [mean pulmonary artery pressure (mPAP); 50,6 mmHg, pulmonary wedge pressure (PWP); 11,3 mmHg, pulmonary vascular resistance (PVR); 11,9 Wood’s units (WU)] irreversible in the test with inhaled nitric oxide. Oxygen saturation (SaO2) of blood samples obtained during the first RHC ranged from 69.3 to 73.2%. Idiopathic pulmonary arterial hypertension was diagnosed. Treatment with inhaled iloprost and sildenafil was initiated. Control RHC, performed 5 months later showed values of mPAP (59,7 mmHg) and PVR (13,4 WU) higher in comparison to the initial measurement, SaO2 of blood obtained during RHC from upper lobe artery of the right lung was elevated and amounted 89.7%. Then, pulmonary arteriography was performed. Lack of contrast in the right upper lobe artery with the evidence of retrograde blood flow visible as a negative contrast in the right pulmonary artery was found. Afterwards, right subclavian artery arteriography detected a huge vascular malformation communicating with right upper lobe artery. Following computed tomography angiogram (angio-CT) additionally revealed the enlargement of bronchial arteries originated fistulas to pulmonary artery of right upper lobe. In spite of intensive pharmacological treatment, including the therapy of pulmonary hypertension and percutaneous embolisation of the fistulas, the patient’s condition continued to deteriorate further. He died three months after embolisation due to severe heart failure complicated by pneumonia. Conclusion Non-congenital SA-PAFs are extremely rare, however, they should be excluded in patients with pulmonary arterial hypertension and history of inflammatory or infectious disease of the lung and pleura, pneumothorax, cancer or Takayashu’s disease and after chest trauma.
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Affiliation(s)
- Wojciech Jacheć
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, 10 Curie-Sklodowska str, 41-808, Zabrze, Poland.
| | - Andrzej Tomasik
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, 10 Curie-Sklodowska str, 41-808, Zabrze, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 14/18 Borowa str, 05-400, Otwock, Poland
| | - Radosław Pietura
- Department of Radiography Medical, University of Lublin, Staszica 11 str., 20-081, 20-954, Lublin, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 14/18 Borowa str, 05-400, Otwock, Poland
| | - Jan Głowacki
- Department of Radiology and Nuclear Medicine, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, 13-15 3-go Maja str, 41-800, Zabrze, Poland
| | - Ewa Nowalany-Kozielska
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, 10 Curie-Sklodowska str, 41-808, Zabrze, Poland
| | - Celina Wojciechowska
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, 10 Curie-Sklodowska str, 41-808, Zabrze, Poland
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Fra Fernández S, Gorospe Sarasúa L, Olavarría Delgado A, Velasco Álvarez D. Systemic-to-Pulmonary Artery Fistula as a Late Complication of Biliary Surgery. Arch Bronconeumol 2018; 55:227-228. [PMID: 30098842 DOI: 10.1016/j.arbres.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Sara Fra Fernández
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - Luis Gorospe Sarasúa
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, España
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Restrepo CS, Vargas D, Martinez-Jimenez S, Ocazionez D. Post-operative imaging of pulmonary vessels. Cardiovasc Diagn Ther 2018; 8:362-371. [PMID: 30057882 DOI: 10.21037/cdt.2018.03.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Complications following cardiothoracic surgery are responsible for prolonged hospital stay, increase cost in patient care and increased morbidity and mortality. Vascular complications in particular are significant contributors to poor patient outcome due to either hemorrhage or thrombosis and ischemia. Evaluation of vascular complications in the postoperative patient requires a rapid and reliable imaging approach. Vascular complications after cardiothoracic surgery include pulmonary artery thrombosis, pseudoaneurysm, pulmonary vein thrombosis, vascular fistulas, stenosis and infarction. Multidetector CT (MDCT), often the imaging modality of choice, offers a one-stop-shop capability to visualize the entire cardiothoracic vasculature, airways, lung parenchyma, mediastinum and chest wall with excellent temporal and spatial resolution.
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Affiliation(s)
- Carlos Santiago Restrepo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Daniel Vargas
- Department of Radiology, University of Colorado in Denver, Denver, CO, USA
| | | | - Daniel Ocazionez
- Department of Radiology, University of Texas Health Science Center at Houston, Houston, TX, USA
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11
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Shimmyo T, Omori T, Hirano A, Masuda M. Secondary systemic artery to pulmonary artery and pulmonary vein fistulas following the video-assisted thoracic surgery for pneumothorax: a case report. Surg Case Rep 2018; 4:1. [PMID: 29292473 PMCID: PMC5748388 DOI: 10.1186/s40792-017-0407-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/12/2017] [Indexed: 11/21/2022] Open
Abstract
Background The systemic artery to pulmonary vessel fistula (SAPVF) is a vascular anomaly characterized by penetration of nonbronchial systemic chest wall arteries into the lung parenchyma. To our knowledge, about 150 cases of SAPVF have been reported to date. Fifteen percent of SAPVF are congenital and occur in the presence of cardiopathy or pulmonary artery hypoplasia. Secondary SAPVF are caused by pleural adhesions that occur subsequent to inflammatory changes associated with conditions such as pleuritis, empyema, trauma, and surgery. Though several cases of secondary SAPVF as a post coronary artery bypass graft (CABG) complication have been reported, secondary SAPVF especially following video-assisted thoracic surgery (VATS) are relatively rare. Case presentation A 19-year-old man was admitted to our hospital because of recurrence of left pneumothorax. His previous history included left and right pneumothorax at the ages of 15 and 16 years, respectively, which were treated by VATS. VATS was planned for the surgical indication of second postoperative recurrence. In the operation, the lingular segment with dilated pulsating pulmonary vessels adhered to the port scar of the chest wall, which was made at first VATS for pneumothorax. The computed tomography showed an abnormal connection between the branch of the systemic artery of the chest wall and the dilated pulmonary artery and pulmonary vein in the lingular segment. Left subclavian selective arteriography also showed hypertrophic blood vessels arose from the internal thoracic artery, the lateral thoracic artery, and the subscapular artery, which drained into the both the pulmonary artery and the pulmonary vein in the lingular segment. Despite of four sessions of embolization for aberrant arteries, the abnormal blood flow persisted. Partial resection of the left lingular segment was therefore performed. The patient has been disease-free about SAPVF for 2 years and 2 months after the last operation. Conclusions We described our experience with a case of secondary SAPVF that was associated with fistulas between a systemic artery and both the pulmonary artery and pulmonary vein, which was developed after first VATS for pneumothorax. Radical resection was safely performed and effective after four sessions of embolization.
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Affiliation(s)
- Takuo Shimmyo
- Department of Thoracic Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa, 238-8567, Japan.
| | - Takahiro Omori
- Department of Thoracic Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa, 238-8567, Japan
| | - Akira Hirano
- Department of Radiology, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa, 238-8567, Japan
| | - Munetaka Masuda
- Department of Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku Yokohama City, Kanagawa, 236-0004, Japan
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12
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Legras A, Azarine A, Poitier B, Messas E, Le Pimpec-Barthes F. Systemic Artery to Pulmonary Vein Fistula After Right Upper Lobectomy Demonstrated by 4-Dimensional Flow Magnetic Resonance Imaging. Ann Thorac Surg 2017; 104:e169-e171. [DOI: 10.1016/j.athoracsur.2017.02.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/05/2017] [Accepted: 02/17/2017] [Indexed: 11/26/2022]
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13
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Ansari-Gilani K, Gilkeson RC, Hsiao EM, Rajiah P. Unusual Pulmonary Arterial Filling Defect caused by Systemic to Pulmonary Shunt in the Setting of Chronic Lung Disease Demonstrated by Dynamic 4D CTA. J Radiol Case Rep 2016; 9:17-23. [PMID: 27252791 DOI: 10.3941/jrcr.v9i11.2480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Even though pulmonary embolism is by far the most common cause of filling defect in the pulmonary arterial system, other less common etiologies should be considered especially in the setting of atypical clinical scenario or unusual imaging findings. Unusual pattern of filling defect in the pulmonary artery in the setting of chronic inflammatory/fibrotic parenchymal lung disease should raise the concern for systemic to pulmonary artery shunt. This diagnosis is typically made by conventional angiography. Dynamic 4D CT angiography however can be a safe, noninvasive and effective alternative tool for making such a diagnosis. It has the added value of multiplanar reconstruction capabilities and providing detailed anatomy which can be vital for interventional radiologists when planning their approach for possible intervention. We present 2 cases of such shunts, and illustrate the demonstration of these shunts by using dynamic 4D CT angiography.
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Affiliation(s)
- Kianoush Ansari-Gilani
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
| | - Robert C Gilkeson
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
| | - Edward M Hsiao
- Department of Radiology, Macquarie University Hospital, Macquarie University, Australia
| | - Prabhakar Rajiah
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
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14
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El Ghannudi S, Germain P, Jeung MY, Jahn C, Hirschi S, Roy C. Multimodality Imaging Diagnostic Approach of Systemic-to-Pulmonary Vein Fistulae. Echocardiography 2015; 33:484-7. [PMID: 26603830 DOI: 10.1111/echo.13116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A 26-year-old man with a history of bilateral lung transplantation for pulmonary cystic fibrosis 6 months before was admitted in our institution for acute heart failure. Cardiac magnetic resonance imaging (CMR) showed an increased aortic output, as aortic flow assessed by velocity mapping was twofold the pulmonary flow, an occluded superior vena cava (SVC), and enlarged azygos vein. A systemic-to-pulmonary vein fistula (SAPVF) was suspected. The selective angiography showed numerous fistulae between intercostals, thyro-cervical, internal mammary arteries and pulmonary veins. The thoracic CT performed before the CMR, which was initially considered as normal, showed well these arteriovenous fistulae after 3D MIP reconstruction. This particular observation highlights the great value of multimodality imaging for the diagnosis of this rare pathology. The MR velocity mapping is a noninvasive imaging technique of great interest to guide the diagnosis of arteriovenous fistulae, and further indicating more invasive complementary imaging modalities like selective arterial angiography.
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Affiliation(s)
- Soraya El Ghannudi
- Department of Radiology, University Hospital of Strasbourg, Strasbourg, France.,Department of Nuclear Medicine, University Hospital of Strasbourg, Strasbourg, France.,Faculty of Medicine, ICube, UMR 7357 University of Strasbourg/CNRS and FMTS, Strasbourg, France
| | - Philippe Germain
- Department of Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Mi-Young Jeung
- Department of Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Christine Jahn
- Department of Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Sandrine Hirschi
- Department of Pneumology, University Hospital of Strasbourg, Strasbourg, France
| | - Catherine Roy
- Department of Radiology, University Hospital of Strasbourg, Strasbourg, France
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Teguh Ryanto GR, Nakayama K, Takaya T, Fujimoto D, Kinutani H, Shinkura Y, Mori S, Okada T, Nishii T, Kono A, Shinke T, Emoto N, Hirata KI. Use of Coils and a Pulmonary Vasodilator to Reduce Pulmonary Hypertension in a Patient with Interstitial Pneumonia and Scleroderma. Intern Med 2015; 54:2721-6. [PMID: 26521900 DOI: 10.2169/internalmedicine.54.4976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Fistulas between systemic and pulmonary arteries are associated with various underlying etiologies and cause pulmonary hypertension (PH). Diagnosis of this condition requires several imaging studies and the exclusion of other possible causes of PH. We herein report a case of a patient with interstitial pneumonia and scleroderma. The imaging revealed multiple fistulas involving the inferior phrenic and left lower pulmonary arteries. The fistulas were closed using coils, but the PH remained presumably due to other undiagnosed fistulas. The improvement of symptoms following use of a supplementary pulmonary vasodilator provides the hope that the chosen treatment could be a viable alternative approach for other similar cases.
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Affiliation(s)
- Gusti Rizky Teguh Ryanto
- Division of Cardivascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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16
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Kaplan T, Atac GK, Ekmekci P, Ozturk E, Han S. Surgical correction of a fistula between left pulmonary artery and innominate vein. Ann Thorac Surg 2014; 98:2204-6. [PMID: 25468090 DOI: 10.1016/j.athoracsur.2014.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/02/2014] [Accepted: 01/14/2014] [Indexed: 11/25/2022]
Abstract
A 48-year-old woman with chronic dyspnea complaints was referred to the thoracic surgery clinic for a surgical lung biopsy to make a definitive diagnosis of interstitial lung disease. Thoracic computed tomography imaging revealed a vascular structure located anterior to the aorta, between the left innominate vein and the pulmonary artery. Magnetic resonance angiography showed the abnormal vessel connection in detail. Pulmonary perfusion scintigraphy showed decreased perfusion of the left upper lobe and the superior lingular segment. A fistulectomy was performed through a mini thoracotomy. The patient no longer had any dyspnea symptoms after the operation.
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Affiliation(s)
- Tevfik Kaplan
- Department of Thoracic Surgery, Ufuk University School of Medicine, Ankara, Turkey.
| | - Gokce Kaan Atac
- Department of Radiology, Ufuk University School of Medicine, Ankara, Turkey
| | - Perihan Ekmekci
- Department of Anesthesiology, Ufuk University School of Medicine, Ankara, Turkey
| | - Emel Ozturk
- Department of Nuclear Medicine, Ufuk University School of Medicine, Ankara, Turkey
| | - Serdar Han
- Department of Thoracic Surgery, Ufuk University School of Medicine, Ankara, Turkey
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Internal mammary artery-to-pulmonary artery and vein fistula acquired after video-assisted thoracoscopic surgery and pleurodesis. J Vasc Interv Radiol 2014; 24:1759-61. [PMID: 24160836 DOI: 10.1016/j.jvir.2013.05.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 05/11/2013] [Accepted: 05/26/2013] [Indexed: 11/20/2022] Open
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18
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Cho SH, Sung YM, Kim JH, Kim YK, Lee JI. Axillary artery to pulmonary artery fistula following Nuss procedure for pectus excavatum. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:570-3. [PMID: 23518629 DOI: 10.5761/atcs.cr.12.02140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Systemic artery to pulmonary vessel fistula (SAPVF) is an uncommon condition, which is congenital or acquired. We recently encountered a patient with acquired axillary artery to pulmonary artery fistula detected by dual-source 64-slice computed tomography (DSCT) angiography who had a Nuss surgical procedure for pectus excavatum. He suffered from wound infection following bar removal. Conventional angiography also demonstrated the SAPVF and successful embolization for treatment was carried out using microcoils and polyvinyl alcohol particles. To our knowledge, there has been no report of an axillary artery to pulmonary artery fistula associated with wound infection following a Nuss procedure.
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Affiliation(s)
- So Hyun Cho
- Department of Radiology, Gil Hospital, Gachon University of Medicine and Science
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19
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Bito Y, Hattori K, Kato Y, Motoki M, Shibata T. Mitral valve surgery in a patient with systemic artery-to-pulmonary artery fistulas. Ann Thorac Surg 2012; 94:1348-9. [PMID: 23006697 DOI: 10.1016/j.athoracsur.2012.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 12/30/2011] [Accepted: 02/02/2012] [Indexed: 11/29/2022]
Abstract
We report the case of a 68-year-old woman with severe mitral valve regurgitation and concomitant multiple systemic artery-to-pulmonary artery fistulas. Endovascular embolization of the fistulas was unable to control her heart failure, and mitral valve replacement was also performed. Steps were taken during mitral valve surgery to ensure an adequate operative field in the left atrium, despite the large volume of in-pouring blood from the pulmonary vein.
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Affiliation(s)
- Yasuyuki Bito
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan.
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Leduc F, Thipphavong S, Matzinger F, Dennie C, Sundaresan S. Unusual presentation of a complication after pulmonary wedge resection for coccidioma. Ann Thorac Surg 2010; 88:2011-3. [PMID: 19932281 DOI: 10.1016/j.athoracsur.2009.04.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 04/09/2009] [Accepted: 04/15/2009] [Indexed: 11/19/2022]
Abstract
We report an unusual presentation of a complication after pulmonary wedge resection. A patient with a history of pulmonary wedge resection for coccidioma presented postoperatively with dyspnea and severe hypoxemia. Cerebral infarctions were diagnosed less than 1 year later. Cardiac magnetic resonance imaging and pulmonary angiogram revealed a pulmonary arteriovenous fistula. Surgical resection of the pulmonary arteriovenous fistula led to improved oxygen saturation and discontinuation of home oxygen.
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Affiliation(s)
- François Leduc
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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21
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Imagerie des complications survenant après chirurgie de résection pulmonaire. ACTA ACUST UNITED AC 2009; 90:1001-12. [DOI: 10.1016/s0221-0363(09)73238-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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22
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Swami N, Thingnam SKS, Singh H. Cavernous hemangioma of the bronchial wall: A systemic-pulmonary vessel fistula. J Thorac Cardiovasc Surg 2008; 137:1272-3. [PMID: 19380003 DOI: 10.1016/j.jtcvs.2008.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 03/09/2008] [Accepted: 04/08/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Naveen Swami
- Department of Cardiothoracic and Vascular Surgery, Pgimer, Chandigarh, India.
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Endovascular repair of a left axillary-left pulmonary artery fistula: report of a case. Surg Today 2007; 37:980-3. [PMID: 17952531 DOI: 10.1007/s00595-007-3503-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2006] [Accepted: 01/10/2007] [Indexed: 10/22/2022]
Abstract
An abnormal communication between an artery of the systemic circulation and a pulmonary artery represents a rare clinical condition. A 76-year-old man presented with nocturnal dyspnea and retrosternal pain caused by a non-ST-elevation acute coronary syndrome. He had a history of a coronary artery bypass grafting operation 17 years previously, which required a repeat procedure 7 years later with a construction of an anastomosis of the left internal thoracic artery to the left anterior descending artery. Coronary angiography revealed an abnormal fistulous communication between the left axillary and the left pulmonary artery. Pressure measurements revealed pulmonary hypertension. An endovascular repair of the fistula was performed during repeat coronary angiography with an implantation of two self-expandable covered polytetrafluoroethylene stent grafts measuring 9 and 10 mm in diameter respectively, and thus resulting in a complete obstruction of the abnormal communication. During a follow-up period of 2 months the patient showed a significant improvement in his clinical condition.
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Fateh-Moghadam S, Dietz R, Bocksch W. Postoperative pulmonary arteriovenous fistula resulting in recurrent cryptogenic stroke. Int J Cardiol 2007; 117:e43-5. [PMID: 17198738 DOI: 10.1016/j.ijcard.2006.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Accepted: 11/02/2006] [Indexed: 11/22/2022]
Abstract
We report on a 66-year-old patient with a history of two cryptogenic strokes and a patent foramen ovale (PFO) who received a transcatheter closure of his PFO in our institution, but shortly after the intervention there was still a relevant right-to-left shunt. The following work-up showed an isolated pulmonary arteriovenous fistula as the real cause for the right-to-left shunt and hence the two strokes.
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Abstract
STUDY OBJECTIVES To conduct a detailed morphologic and ultrastructural study of pleural adhesions following talc pleurodesis. METHODS Talc with a main particle size of 8.36 +/- 0.2 mum (mean +/- SEM) and at a dose of 200 mg/kg in a 2-mL slurry was instilled via a small catheter into the pleural cavity of 10 male rabbits. Five rabbits were killed at 1 week, and five rabbits were killed at 1 month after instillation. At autopsy, after macroscopically observing the pleural cavity, adhesions were excised from opposing pleural surfaces and processed for histopathologic, immunocytochemical, and ultrastructural study. RESULTS At 1 week, all adhesions examined were mesothelium-covered fibrovascular bands containing well-developed blood and lymphatic vessels establishing a structural continuity between both pleural layers. Nerves were present in adhesions from 20% of the rabbits. They consisted of a single fascicle containing 5 to 20 thin myelinated axons of various diameters (1 to 6 microm) uniformly distributed throughout the nerve section. The anatomic location of the adhesion did not appear to influence its overall morphology. CONCLUSIONS As early as at 1 week, adhesions are well-formed structures more resembling newly formed pleural tissue than a simple scar. Nerve fibers in pleural adhesions are reported for the first time, which suggests that these adhesions are potentially capable of conducting pain stimuli. Further studies are required in order to confirm our results in human pleural adhesions.
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Affiliation(s)
- Juan F Montes
- Departament de Biologia Cellular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.
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Abstract
Corticosteroids (predominantly prednisolone and hydrocortisone) and adrenocorticotropic hormone (ACTH) have been used in the treatment of the epilepsies for over 50 years. Over the past 30 years most reports have focused on epilepsy syndromes and epileptic encephalopathies resistant to treatment with the more conventional anticonvulsant and antiepileptic drugs (AEDs) and specifically West syndrome. There has been relatively little attention on the role of corticosteroids in treating other epilepsies.
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Affiliation(s)
- R Gupta
- The Roald Dahl EEG Unit, Department of Neurology, Royal Liverpool Children's NHS Trust (Alder Hey), Liverpool, UK
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