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Riestra Guiance I, Meade C, McCambridge A, Bendel E, Kern R. Pulmonary artery pseudoaneurysm arising from primary lung neoplasm: A proposed mechanism. Respir Med Case Rep 2023; 47:101965. [PMID: 38283187 PMCID: PMC10821629 DOI: 10.1016/j.rmcr.2023.101965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/09/2023] [Accepted: 12/17/2023] [Indexed: 01/30/2024] Open
Abstract
Pulmonary artery pseudoaneurysms (PAPs) are rare and life-threatening occurrences. We present a 57-year-old male patient with squamous cell lung cancer, who presented with hemoptysis. Bronchoscopy did not reveal ongoing bleeding. Imaging showed a left lower lobe tumor, a cavitary lesion communicating with the bronchus, and a pulmonary artery pseudoaneurysm. Successful embolization of the originating segmental branch of the pulmonary artery was performed. The pathogenesis of PAPs associated with primary lung malignancies remains poorly understood. We propose a four-step mechanism involving primary tumor expansion, central cavitary necrosis, direct arterial invasion, inflammatory response, vessel wall damage, pseudoaneurysm formation, and subsequent filling of the former cavitary lesion. This case emphasizes the importance of considering PAPs in primary lung malignancies, particularly in male patients with squamous cell pathology. Understanding the proposed pathogenic mechanism could lead to early detection, prompt intervention, and improved outcomes.
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Affiliation(s)
| | - Charles Meade
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amanda McCambridge
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Emily Bendel
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ryan Kern
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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2
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Khanna L, Vargas D, Menias C‘C, Katabathina V. Oncologic Emergencies in the Chest, Abdomen, and Pelvis. Radiol Clin North Am 2023; 61:91-110. [DOI: 10.1016/j.rcl.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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A Rare Case of Peripheral Pulmonary Artery Aneurysm and Cavitating Pneumonia in a Patient with COVID-19 Managed with an Endovascular Method. Radiol Case Rep 2022; 17:3694-3698. [PMID: 35936879 PMCID: PMC9342831 DOI: 10.1016/j.radcr.2022.06.087] [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: 05/30/2022] [Revised: 06/19/2022] [Accepted: 06/25/2022] [Indexed: 11/20/2022] Open
Abstract
Peripheral pulmonary artery aneurysm (PAA), being a rare condition, is considered extremely rare following coronavirus disease 2019 (COVID-19). We present a 58-year-old male who presented with fever, malaise, and dry cough. SARS-CoV-RNA transcription-mediated amplification test was positive for the patient. After 2 days, he developed hemoptysis and back pain, and a CT scan revealed a pulmonary aneurysm, evidence of alveolar hemorrhage, and Necrotizing pneumonia. He was scheduled for pulmonary artery angiography. The angiography confirmed a fusiform aneurysm and partial coiling of the aneurysmal sac, and indoor and backdoor embolization was performed. In the follow-up, a CT scan showed complete thrombosis of the aneurysmal sac, and the patient was free of symptoms. Peripheral PAAs can show a variety of symptoms. They can even be asymptomatic. The infectious pathologies of this condition are less common than the other. COVID-19 is an extremely rare pathology. To the best of our knowledge, this is the first case of necrotizing pneumonia and peripheral PPA in an adult. Moreover, it was followed by COVID-19. A vital takeaway note for physicians is to consider PAAs as a complication when treating COVID-19 patients who don't show signs of improvement or even show signs of exacerbation.
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Fukuda Y, Homma T, Uno T, Murata Y, Suzuki S, Shiozawa E, Takimoto M, Sagara H. Fatal rupture of pulmonary artery pseudoaneurysm after thoracic radiation therapy against lung squamous cell carcinoma: A case report and literature review. Clin Case Rep 2021; 9:737-741. [PMID: 33598236 PMCID: PMC7869342 DOI: 10.1002/ccr3.3647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/14/2020] [Accepted: 11/24/2020] [Indexed: 01/01/2023] Open
Abstract
Pulmonary artery pseudoaneurysm is a rare but fatal condition. It has been associated with lung cancer, abscesses, and radiation therapy. Identification in patients with hemoptysis is critical, and timely interventional therapy is warranted.
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Affiliation(s)
- Yosuke Fukuda
- Department of MedicineDivision of Respiratory Medicine and AllergologyShowa University School of MedicineTokyoJapan
| | - Tetsuya Homma
- Department of MedicineDivision of Respiratory Medicine and AllergologyShowa University School of MedicineTokyoJapan
| | - Tomoki Uno
- Department of MedicineDivision of Respiratory Medicine and AllergologyShowa University School of MedicineTokyoJapan
| | - Yasunori Murata
- Department of MedicineDivision of Respiratory Medicine and AllergologyShowa University School of MedicineTokyoJapan
| | - Shintaro Suzuki
- Department of MedicineDivision of Respiratory Medicine and AllergologyShowa University School of MedicineTokyoJapan
| | - Eisuke Shiozawa
- Department of PathologyShowa University School of MedicineTokyoJapan
| | - Masafumi Takimoto
- Department of PathologyShowa University School of MedicineTokyoJapan
| | - Hironori Sagara
- Department of MedicineDivision of Respiratory Medicine and AllergologyShowa University School of MedicineTokyoJapan
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Kang T, Kang MJ. Pulmonary artery pseudoaneurysm showing rapid growth in a patient with lung cancer. Radiol Case Rep 2020; 15:2144-2148. [PMID: 32952752 PMCID: PMC7484516 DOI: 10.1016/j.radcr.2020.07.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022] Open
Abstract
Pulmonary artery pseudoaneurysm is rare and is usually associated with infection. In this report, we describe the case of a patient with pulmonary artery pseudoaneurysm in association with pulmonary squamous cell carcinoma. A 64-year-old man with a previous history of lung cancer showed massive hemoptysis and large consolidation in the right lower lung. Emergency radiologist interpreted this lesion as cancer progression or hematoma. Thus, emergency bronchial and intercostal angiography were performed. However, during admission, the patient presented with another episode of massive hemoptysis. A thoracic radiologist reviewed the previous computed tomography scans and noted the presence of a large hematoma in the right lower lobe of the lung; a pseudoaneurysm was seen within the hematoma arising from the pulmonary artery. On follow up computed tomography, the pseudoaneurysm showed rapid growth. Thus, the patient underwent embolization for the branch of the right lower lobar pulmonary artery using coil and histoacryl. Misdiagnosis of pulmonary artery pseudoaneurysm could be fatal; hence, radiologists should be familiar with the features of pulmonary artery pseudoaneurysm.
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Affiliation(s)
- Taekyung Kang
- Department of Emergency Medicine, Inje University, Sanggye Paik Hospital, Seoul, South Korea
| | - Mi-Jin Kang
- Department of Radiology, Inje University, Sanggye Paik Hospital, Seoul, South Korea
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Yildiz O, Unal E, Ciftci TT, Akinci D, Ariyurek OM. An unusual presentation of pulmonary artery sarcoma: Several pseudoaneurysms with massive hemoptysis. Am J Emerg Med 2020; 38:1966.e1-1966.e3. [PMID: 32444291 DOI: 10.1016/j.ajem.2020.05.004] [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: 04/25/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022] Open
Abstract
A 53-year-old woman was admitted to the emergency department with sudden onset of massive hemoptysis. She had previous history of dyspnea and cough for two months. She had no history of chronic disease, smoking, or use of anticoagulant and antiplatelet drugs. On arrival, she was tachycardic and tachypneic, but her body temperature was normal. Chest X-ray showed enlarged right hilus and multiple nodular opacities predominantly in the left lung basis. Computed tomography (CT) scan of the chest demonstrated massive intraluminal filling defect extending from the right pulmonary artery through the main and left pulmonary arteries. Pulmonary artery sarcoma (PAS) was the preliminary imaging-based diagnosis. However, CT also revealed presence of several pseudoaneurysms arising from the distal branches of the left pulmonary artery encased by metastatic nodules. Although hemoptysis is an uncommon presentation for patients with PAS, accompanied pseudoaneurysms were the main reason for massive hemoptysis. Differentiation of PAS from bland thromboembolism could be challenging on CT. Herein reported case provides an additional imaging feature that may utilize differentiating pulmonary artery sarcoma from bland thrombus.
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Affiliation(s)
- Oguzhan Yildiz
- Department of Radiology, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Emre Unal
- Department of Radiology, Hacettepe University School of Medicine, Ankara 06100, Turkey.
| | - Turkmen Turan Ciftci
- Department of Radiology, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Devrim Akinci
- Department of Radiology, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Orhan Macit Ariyurek
- Department of Radiology, Hacettepe University School of Medicine, Ankara 06100, Turkey
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Park HS, Chamarthy MR, Lamus D, Saboo SS, Sutphin PD, Kalva SP. Pulmonary artery aneurysms: diagnosis & endovascular therapy. Cardiovasc Diagn Ther 2018; 8:350-361. [PMID: 30057881 DOI: 10.21037/cdt.2018.04.01] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary artery aneurysms (PAAs) and pseudoaneurysms are rare entities in the spectrum of pulmonary arterial diseases. The etiology of these aneurysms is varied and patients present with nonspecific symptoms which make their diagnosis both difficult and less often considered. In this review, we will discuss the clinical manifestations, etiologies, methods of detection, imaging features, and the current role of endovascular treatment in the management of PAAs.
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Affiliation(s)
- Harold S Park
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Murthy R Chamarthy
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel Lamus
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sachin S Saboo
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Patrick D Sutphin
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sanjeeva P Kalva
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Pulmonary Artery Pseudoaneurysm: A Rare Cause of Fatal Massive Hemoptysis. Case Rep Pulmonol 2018; 2018:8251967. [PMID: 29850353 PMCID: PMC5937510 DOI: 10.1155/2018/8251967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/15/2018] [Indexed: 11/18/2022] Open
Abstract
Pulmonary artery pseudoaneurysm (PAPA), an uncommon complication of pyogenic bacterial and fungal infections and related septic emboli, is associated with high mortality. The pulmonary artery (PA) lacks an adventitial wall; therefore, repeated endovascular seeding of the PA with septic emboli creates saccular dilations that are more likely to rupture than systemic arterial aneurysms. The most common clinical presentation of PAPA is massive hemoptysis and resultant worsening hypoxemia. Computed tomography angiography is the preferred diagnostic modality for PAPA; typical imaging patterns include focal outpouchings of contrast adjacent to a branch of the PA following the same contrast density as the PA in all phases of the study. In mycotic PAPAs, multiple synchronous lesions are often seen in segmental and subsegmental PAs due to ongoing embolic phenomena. The recommended approach for a mycotic PAPA is prolonged antimicrobial therapy; for massive hemoptysis, endovascular treatment (e.g., coil embolization, stenting, or embolization of the feeding vessel) is preferred. PAPA resection and lobectomy are a last resort, generally reserved for patients with uncontrolled hemoptysis or pleural hemorrhage. We present a case of a 28-year-old woman with necrotizing pneumonia from intravenous drug use who ultimately died from massive hemoptysis and shock after a ruptured PAPA.
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Shum PL, Ngo B, Chen X, Jarvis R. Pulmonary artery pseudoaneurysm secondary to metastatic breast cancer. South Asian J Cancer 2018; 7:20. [PMID: 29600227 PMCID: PMC5865088 DOI: 10.4103/sajc.sajc_157_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Pey Ling Shum
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia, Johor Bahru, Johor Malaysia.,Department of Radiology, Bendigo Health, Bendigo VIC, Australia
| | - Brian Ngo
- Department of Radiology, Austin Health, Heidelberg VIC, Australia
| | - Xiao Chen
- Department of Radiology, Bendigo Health, Bendigo VIC, Australia.,Department of Radiology, Austin Health, Heidelberg VIC, Australia
| | - Robert Jarvis
- Department of Radiology, Bendigo Health, Bendigo VIC, Australia
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Lin CT, Raman SP, Fishman EK. An algorithmic approach to CT of pulmonary arterial disorders. Clin Imaging 2016; 40:1226-1236. [DOI: 10.1016/j.clinimag.2016.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/05/2016] [Accepted: 08/22/2016] [Indexed: 01/10/2023]
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Abstract
OBJECTIVE The purpose of this study was to analyze the clinical and CT features of pulmonary artery pseudoaneurysms (PAPs). MATERIALS AND METHODS A database search of chest CT examinations performed from January 1, 2000 to December 31, 2014 identified 24 patients with findings consistent with PAPs. A CT finding consistent with a PAP was defined as a focal saccular outpouching of a pulmonary artery. Medical records were reviewed to determine clinical presentations, treatments, and outcomes. CT scans were reviewed by two board-certified fellowship-trained chest radiologists. RESULTS A total of 35 PAPs were identified in 24 patients. Hemoptysis and shortness of breath were the most common presenting symptoms. The most commonly identified causes of PAPs were infection (33%), neoplasms (13%), and trauma (17%). Of the 35 PAPs, 29 (83%) were located in segmental or subsegmental pulmonary arteries. A solitary PAP was identified in 20 (83%) patients, and multiple PAPs were identified in three patients with endocarditis and one patient with pulmonary metastases. Only three of 35 (9%) PAPs were associated with a ground-glass halo. Endovascular treatment was successfully performed in 12 patients, and only one patient had immediate recurrent hemoptysis after treatment. PAP was clinically suspected by the referring clinicians in only three patients. Sixteen of the 35 (46%) PAPs were not reported on the initial CT studies. CONCLUSION PAPs showed a strong predilection for the peripheral pulmonary arteries. Multiplicity of PAPs can be seen in the settings of endocarditis and pulmonary metastatic disease. Most PAPs were not associated with a ground-glass halo. PAPs can be lethal but were often not suspected clinically and were underreported by radiologists.
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Garg S, King G, Varadi G. Pseudoaneurysm of pulmonary artery: rare complication of systemic chemotherapy. Clin Case Rep 2015; 3:845-8. [PMID: 26509021 PMCID: PMC4614654 DOI: 10.1002/ccr3.363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/17/2015] [Accepted: 06/30/2015] [Indexed: 11/12/2022] Open
Abstract
Pulmonary artery pseudoaneurysm is an uncommon yet fatal clinical entity. Its presentation can mimic a number of common diseases and can be easily missed. As pseudoaneurysm is associated with a number of fatal complications, clinicians should be aware of imaging features which distinguishes pseudoaneurysms from its close differentials. Early recognition and treatment of pseudoaneurysm can prevent fatal outcomes including hemothorax, rupture, or death.
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Affiliation(s)
- Shivani Garg
- Department of Internal Medicine, Albert Einstein Medical Center Philadelphia, Pennsylvania
| | - Gentry King
- Department of Internal Medicine, Albert Einstein Medical Center Philadelphia, Pennsylvania
| | - Gabor Varadi
- Department of Hematology and Oncology, MOHA Cancer Center, Albert Einstein Medical Center Philadelphia, Pennsylvania
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Zhang J, Jiang S. Massive haemoptysis from a central pulmonary arterial pseudoaneurysm secondary to advanced lung cancer: successful treatment by Guglielmi detachable coil embolization. CLINICAL RESPIRATORY JOURNAL 2015; 11:258-262. [PMID: 26076714 DOI: 10.1111/crj.12333] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 05/31/2015] [Accepted: 06/12/2015] [Indexed: 11/28/2022]
Abstract
Massive haemoptysis is a life-threatening condition in patients with lung cancer. Endovascular embolization has been well-established as an effective means of treating this condition. Haemoptysis of pulmonary arterial origin is rare, and a pulmonary artery pseudoaneurysm (PAP) is generally the main cause. PAP due to lung cancer is also very rare, and the site of bleeding always involves the peripheral lung. We report an unusual case of central PAP secondary to advanced central squamous-cell carcinoma of the lung in a patient with acute massive haemoptysis. The sac of the pseudoaneurysm underwent successful embolization using various Guglielmi detachable coils (GDCs). The patient died of lung cancer without recurrence of haemoptysis 42 days post-embolization. To the best of our knowledge, this case report is the first to describe massive haemoptysis caused by central PAP due to lung cancer and its successful treatment by GDC embolization.
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Affiliation(s)
- Jie Zhang
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China
| | - Sen Jiang
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China
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Katabathina VS, Restrepo CS, Betancourt Cuellar SL, Riascos RF, Menias CO. Imaging of Oncologic Emergencies: What Every Radiologist Should Know. Radiographics 2013; 33:1533-53. [DOI: 10.1148/rg.336135508] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Restrepo CS, Betancourt SL, Martinez-Jimenez S, Gutierrez FR. Tumors of the pulmonary artery and veins. Semin Ultrasound CT MR 2013; 33:580-90. [PMID: 23168066 DOI: 10.1053/j.sult.2012.04.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The pulmonary vasculature may be involved by different primary and secondary tumors. Poorly differentiated and undifferentiated sarcomas are the most common primary tumors of the pulmonary arteries. They tend to affect the large caliber pulmonary vessels and present with predominantly intraluminal growth. Pulmonary and mediastinal metastasis are common, and prognosis is poor. Clinical and imaging manifestations may mimic those of pulmonary embolism. Dyspnea, chest pain, cough, and hemoptysis are the most common presenting symptoms. Primary sarcomas arising from the central pulmonary veins are less common than their arterial counterpart. Secondary involvement of the pulmonary arteries and veins by primary and metastatic pulmonary malignancies is more common. Tumoral embolism may also affect the pulmonary arteries. They may develop from different intrathoracic and extrathoracic malignancies and may be indistinguishable from venous thromboembolism. It may manifest as cor pulmonale with right cardiac strain and dilated pulmonary arteries. Computed tomography, magnetic resonance imaging, and fluorodeoxyglucose positron emission tomography may help in the differentiation between these 2 conditions.
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Affiliation(s)
- Carlos S Restrepo
- Division of Thoracic and Cardiovascular Radiology, Department of Radiology, The University of Texas, Health Science Center, San Antonio, TX 78258, USA.
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Restrepo CS, Carswell AP. Aneurysms and Pseudoaneurysms of the Pulmonary Vasculature. Semin Ultrasound CT MR 2012; 33:552-66. [DOI: 10.1053/j.sult.2012.04.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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