CT appearance of the normal inferior pulmonary ligament

Prevalence of non-bronchial systemic culprit arteries in patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization

OBJECTIVES

To identify the prevalence of non-bronchial systemic culprit arteries and their relationship to bleeding lobes in patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization (BAE).

METHODS

Data of 83 consecutive patients with bronchiectasis and chronic pulmonary infection (non-tuberculous mycobacteriosis, aspergillosis, and tuberculosis) who underwent de novo BAE between January 2019 and December 2020 were retrospectively reviewed. The prevalence of culprit arteries was investigated.

RESULTS

Fifty-five patients (66%) had 172 non-bronchial systemic culprit arteries. The bleeding lobes were the right upper, right middle, right lower, left upper, and left lower lobes in 14 (17%), 20 (24%), 7 (8%), 31 (37%), and 11 (13%) patients, respectively. The internal thoracic (49%; n = 41), intercostal (28%; n = 23), and inferior phrenic (28%; n = 23) arteries were the top three non-bronchial systemic culprit arteries, which were involved in all five types of bleeding lobes. The costocervical trunk and thoracoacromial and lateral thoracic arteries were predominant in patients with upper lobe bleeding. Ligament arteries were predominant in patients with left lower lobe bleeding.

CONCLUSIONS

These findings will better ensure the identification of non-bronchial systemic culprit arteries in patients with hemoptysis with bronchiectasis and chronic pulmonary infection. All systemic arteries, especially those which are adjacent to the lung lesions, should be evaluated carefully using MDCT; the internal thoracic, intercostal, and inferior phrenic arteries should be proactively assessed using angiography.

KEY POINTS

• Non-bronchial systemic culprit arteries were identified in 66% of patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization. • The internal thoracic (49%), intercostal (28%), and inferior phrenic (28%) arteries were the top three arteries, which were involved in all five types of bleeding lobes. • The costocervical trunk and thoracoacromial and lateral thoracic arteries were prominent in patients with upper lobe bleeding, and the ligament artery was prominent in patients with left lower lobe bleeding.

Granulomatous lymphadenitis in the inferior pulmonary ligament

The inferior pulmonary ligament and related connective tissue septa are a recognizable site of granulomatous lymphadenitis on CT of the chest and may mimic a lung parenchymal lesion. The anatomy of the inferior pulmonary ligament, CT appearances and potential etiologies of this entity are reviewed and illustrated.

Microstructure and Mechanical Property of Glutaraldehyde-Treated Porcine Pulmonary Ligament

There is a significant need for fixed biological tissues with desired structural and material constituents for tissue engineering applications. Here, we introduce the lung ligament as a fixed biological material that may have clinical utility for tissue engineering. To characterize the lung tissue for potential clinical applications, we studied glutaraldehyde-treated porcine pulmonary ligament (n = 11) with multiphoton microscopy (MPM) and conducted biaxial planar experiments to characterize the mechanical property of the tissue. The MPM imaging revealed that there are generally two families of collagen fibers distributed in two distinct layers: The first family largely aligns along the longitudinal direction with a mean angle of θ = 10.7 ± 9.3 deg, while the second one exhibits a random distribution with a mean θ = 36.6 ± 27.4. Elastin fibers appear in some intermediate sublayers with a random orientation distribution with a mean θ = 39.6 ± 23 deg. Based on the microstructural observation, a microstructure-based constitutive law was proposed to model the elastic property of the tissue. The material parameters were identified by fitting the model to the biaxial stress-strain data of specimens, and good fitting quality was achieved. The parameter e0 (which denotes the strain beyond which the collagen can withstand tension) of glutaraldehyde-treated tissues demonstrated low variability implying a relatively consistent collagen undulation in different samples, while the stiffness parameters for elastin and collagen fibers showed relatively greater variability. The fixed tissues presented a smaller e0 than that of fresh specimen, confirming that glutaraldehyde crosslinking increases the mechanical strength of collagen-based biomaterials. The present study sheds light on the biomechanics of glutaraldehyde-treated porcine pulmonary ligament that may be a candidate for tissue engineering.

The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review

Accurate lymph node staging of lung cancer is crucial in determining optimal treatment plans and predicting patient outcome. Currently used lymph node maps have been reconciled to the internationally accepted International Association for the Study of Lung Cancer (IASLC) map published in the seventh edition of TNM classification system of malignant tumours. This article provides computed tomographic illustrations of the IASLC nodal map, to facilitate its application in day-to-day clinical practice in order to increase the appropriate classification in lung cancer staging.

Correlative anatomy for thoracic inlet; glottis and subglottis; trachea, carina, and main bronchi; lobes, fissures, and segments; hilum and pulmonary vascular system; bronchial arteries and lymphatics

Because it is relatively inexpensive and universally available, standard radiographs of the thorax should still be viewed as the primary screening technique to look at the anatomy of intrathoracic structures and to investigate airway or pulmonary disorders. Modern trained thoracic surgeons must be able to correlate surgical anatomy with what is seen on more advanced imaging techniques, however, such as CT or MRI. More importantly, they must be able to recognize the indications, capabilities, limitations, and pitfalls of these imaging methods.

The juxtaphrenic peak (Katten's sign) is produced by rotation of an inferior accessory fissure

Tenting of the diaphragm (Katten's sign) is a common finding in upper lobe collapse or where there is loss of volume. Twenty-nine patients have been studied, 12 of these prospectively following upper lobectomy. Division of the inferior pulmonary ligament was carried out in these 12 patients. The computed tomography findings confirm that this sign is due to an accessory oblique fissure.

Inferior pulmonary ligament lymphadenopathy: demonstration by computed tomography

Inferior pulmonary ligament lymphadenopathy is common in bronchogenic carcinoma and may also occur in lymphoma and potentially in any condition which may cause intrathoracic lymphadenopathy. Despite the apparent frequency with which inferior pulmonary ligament lymphadenopathy occurs, we have been unable to find a description of the computed tomographic findings of this condition. In a patient with lymphoma, we found inferior pulmonary ligament lymphadenopathy by computed tomography as an oval, elongated soft-tissue density arising within the inferior pulmonary ligament and still attached to the mediastinum by a piece of the normal ligament. We believe that this appearance should be sufficient for the correct computed tomographic diagnosis of inferior pulmonary ligament lymphadenopathy.

Mediastinal pseudomass: pneumonia and atelectasis behind the left pulmonary ligament

In children, left lower lobe pneumonia posterior to the pulmonary ligament may mimic a paramediastinal mass. Over a period of 6 years we have seen 12 children with this unusual appearance, which we attribute to a peculiar type of atelectasis or infiltration of the left lower lobe or a segment of it. The radiographic appearance is thought to be the result of incomplete anchoring of the left lung by a short pulmonary ligament. The radiographic findings are demonstrated, and the benign clinical course is emphasized.