Case 28: Proximal interruption of the right pulmonary artery

Unilateral proximal interruption of pulmonary artery with ipsilateral interstitial lung disease - A rare case report

Unilateral proximal interruption of pulmonary artery with ipsilateral occurrence of lung fibrosis is a very rare entity. This case report is about a 27 year old male who had complaints of progressive dysponea since 1 year. He had past history of recurrent lower respiratory tract infections. On auscultation, velcro crackles are heard on right side. Pulmonary function test showed restrictive pattern. Chest Radiography, High Resolution Computed Tomography and CT Pulmonary angiography were performed.

Congenital central pulmonary artery anomalies: Part 2

There is a broad spectrum of congenital anomalies of the central pulmonary arteries including abnormalities of development, origin, course and caliber. These anomalies incorporate simple lesions such as isolated pulmonary valve stenosis to very complex anomalies with many associated abnormalities. Part 1 and Part 2 of this review describe the range of anatomical variations that are encountered as well as important aspects of anatomy, physiology and surgical correction. The authors summarize and illustrate both well-recognized and more complex anomalies to provide a broad and comprehensive understanding of these lesions and their appearances on CT and MR imaging. In Part 2 the authors review abnormalities in development, origin and course of the central branch pulmonary arteries as well as abnormal pulmonary artery caliber.

Proximal Interruption of the Pulmonary Artery

Proximal interruption of the pulmonary artery (PIPA) is an uncommon developmental anomaly resulting in underdevelopment of the proximal portion of the pulmonary artery with preservation of the intrapulmonary segments. Clinical presentation ranges between an asymptomatic incidental finding to massive hemoptysis. When findings suggestive of PIPA are present radiographically, the diagnosis of PIPA can be definitively diagnosed with computed tomography or magnetic resonance pulmonary angiography. Other imaging modalities, such as nuclear perfusion scan and catheter angiography can help in the diagnosis.

Congenital anomalies of the pulmonary arteries: an imaging overview

Congenital pulmonary artery anomalies represent a diverse group of abnormalities, ranging from asymptomatic incidental findings to causes of sudden cardiac death. While some may be recognized in childhood, others may be found incidentally in adulthood. We review the clinical and imaging findings in patients with congenital anomalies of the pulmonary arteries, including valvular and perivavular anomalies as well as abnormal narrowing, course and communications of the pulmonary arteries. We also discuss the role of various imaging modalities in the evaluation of these patients. It is vital to be aware of the key radiologic manifestations and associated haemodynamic consequences in these conditions in order to facilitate accurate diagnosis and prognostic stratification.

Anomalies of Pulmonary Circulation as a Cause of Hemoptysis: A Series of Unusual Cases and Review of the Literature

The expectoration of blood originating from the lower respiratory tract, called hemoptysis, is a common clinical condition with many potential etiologies. Massive hemoptysis is life threatening and needs urgent intervention. Multidetector computed tomography (MDCT) is a useful non-invasive imaging modality for the initial assessment of hemoptysis. Using MDCT with multiplanar reformatted images has improved the diagnosis and management of hemoptysis by providing a more precise depiction of bronchial and non-bronchial systemic arteries than conventional computed tomography (CT). In 95% of hemoptysis cases, the systemic arterial system is the origin of bleeding and pulmonary vascular anomalies are a rare cause. Among these, pulmonary arteriovenous malformation, hereditary hemorrhagic telangiectasia, and Osler-Weber-Rendu disease are well known entities. However, primary anomalies affecting pulmonary vessels in the mediastinum or diseases secondarily affecting the pulmonary vessels are unusual causes. Here we present three cases where patients had pulmonary vascular anomalies causing hemoptysis. These patients had decreased pulmonary arterial pressures leading to bronchial and systemic arterial hypertrophy and development of bronchopulmonary collaterals. Secondary CT signs in the parenchyma and mediastinum (mosaic attenuation, ground glass haze, subpleural interstitial thickening, and hypertrophied bronchial arteries) were similar in all patients. Hence, evaluation of the MDCT images for primary abnormality led to the diagnosis.

Congenital absence of the right interlobar pulmonary artery: HRCT findings

We report a case of unilateral idiopathic pulmonary fibrosis-like changes in the right middle and lower lobe without lung volume changes and with normal upper lobe owing to congenital absence of the right interlobar pulmonary artery on chest computed tomography.

Outcomes in 45 children with ductal origin of the distal pulmonary artery

BACKGROUND

There are no large series describing the morphologic spectrum and the clinical outcomes of children with ductal origin of the distal pulmonary artery (PA).

METHODS

Medical records were reviewed for all children presenting between 1970 and 2001. Angiograms were reviewed at presentation and at last available follow-up.

RESULTS

Forty-five patients were identified with median presenting age of 14 days (range, birth to 6.5 years). Ductal origin of the distal PA occurred as an isolated finding in 16 patients (36%), with tetralogy of Fallot in 12 (27%), with pulmonary atresia-ventricular septal defect in 13 (29%), and with heterotaxy in 4 (9%). Diagnostic pulmonary venous wedge angiography was performed in 21 patients (47%). Surgical procedures were undertaken in 31 patients, and were initial systemic-ductal PA shunt in 13 patients, interposition graft in 6, direct anastomosis to the main PA in 2, ductal PA banding in 2, unifocalization of the ductal PA with complete or staged pulmonary atresia-ventricular septal defect repair in 7, and heart transplantation in 1 patient. Surgical revision was required in 3 patients and catheter interventions in 12 patients. Overall 20-year survival was 70% and was improved among patients without congestive heart failure at presentation (p = 0.08, hazard ratio: 2.81). Reconstruction of the ductal PA decreased the prevalence of pulmonary parenchymal hypoplasia (p < 0.001) and scoliosis at last available follow-up.

CONCLUSIONS

Ductal origin of the distal PA is associated with important multisystem morbidity and mortality. Early diagnosis and repair of the ductal PA, especially in children presenting with pulmonary overcirculation, may improve outcomes.

HRCT Findings of Proximal Interruption of the Right Pulmonary Artery

The purpose of this study is to present the characteristic HRCT findings of the lung parenchyma in patients with proximal interruption of the right main pulmonary artery. HRCT findings of proximal interruption of the right pulmonary artery demonstrated reticular opacities, septal thickening, subpleural consolidation, cystic lung changes, and pleural thickening in all 5 patients; bronchial dilation and bronchial wall thickening in 4 patients; and subpleural ground glass opacity (GGO) in 3 patients. The changes may be caused by absent pulmonary artery perfusion and development of systemic vessel collateralization.