scholarly journals Systemic Artery to Pulmonary Artery Shunt Mimicking Acute Pulmonary Embolism, Unmasked by a Multimodality Imaging Approach

Tomography ◽  
2022 ◽  
Vol 8 (1) ◽  
pp. 175-179
Author(s):  
Brieg Dissaux ◽  
Pierre-Yves Le Floch ◽  
Romain Le Pennec ◽  
Cécile Tromeur ◽  
Pierre-Yves Le Roux
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Multimodality Imaging ◽  
Lower Lobe ◽  
Filling Defect ◽  
Pulmonary Angiography ◽  
Systemic Artery ◽  
Imaging Approach ◽  
The Right

In this report, we describe the functional imaging findings of systemic artery to pulmonary artery shunt in V/Q SPECT CT imaging. A 63-year-old man with small-cell lung cancer underwent CT pulmonary angiography (CTPA) for suspected acute pulmonary embolism (PE). The CTPA showed an isolated segmental filling defect in the right lower lobe, which was initially interpreted as positive for PE but was actually the consequence of a systemic artery to pulmonary artery shunt due to the recruitment of the bronchial arterial network by the adjacent tumor. A V/Q SPECT/CT scan was also performed, demonstrating a matched perfusion/ventilation defect in the right lower lobe.

scholarly journals Systemic Artery-to-Pulmonary Artery Fistula Mimics Pulmonary Embolus

2019 ◽  
Vol 9 ◽  
pp. 41
Author(s):  
David Livingston ◽  
Matthew Grove ◽  
Rolf Grage ◽  
J. Mark McKinney
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Embolus ◽  
Lower Lobe ◽  
Filling Defect ◽  
Inferior Phrenic Artery ◽  
Arterial Blood ◽  
Systemic Artery ◽  
Phrenic Artery ◽  
The Right ◽  
Pulmonary Artery Fistula

Systemic artery-to-pulmonary artery fistula (SA-PAF) is a rare phenomenon that can resemble a filling defect on computed tomography angiography (CTA). SA-PAF can be due to congenital or acquired etiologies and can alter the hemodynamics of the pulmonary circulation, with the most serious reported complication being hemoptysis, requiring embolization. We describe a case of an unusual SA-PAF between the right inferior phrenic artery and the right lower lobe pulmonary artery that mimicked an unprovoked pulmonary embolus (PE) on standard CTA in a patient with cardiomyopathy. This SA-PAF was interpreted on CTA as PE due to the presence of a filling defect, revealing that not all filling defects are PE. SA-PAF should always be considered when the clinical context or the imaging findings are atypical, specifically with an isolated filling defect visualized in the inferior lower lobe pulmonary artery. The false-positive PE was the result of mixing of systemic non-opacified blood with opacified pulmonary arterial blood.

scholarly journals A visualized pulmonary arterial thrombus by using a new  echocardiographic view in an intermediate-risk a cute pulmonary embolism  patient: a case report

2019 ◽  
Author(s):  
Guanyu Mu ◽  
Feixue Li ◽  
Xiaolin Chen ◽  
Bo Zhao ◽  
Guangping Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Pulmonary Angiography ◽  
Normal Blood ◽  
Intermediate Risk ◽  
Normal Blood Pressure

Abstract BackgroundAcute pulmonary embolism (APE) is a life-threatening disease with nonspecific clinical signs and symptoms. Rapid and accurate diagnosis is crucial for the clinical management of patients with acute pulmonary embolism. A new recommended echocardiography view may be of further help in the diagnosis, evaluate the change of the thrombosis and treatment effect.Case presentationWe report a case of a 74-year-old man with a 12-day history of decreased exercise capacity and dyspnoea. The patient was diagnosed intermediate-risk APE as several pulmonary emboli in pulmonary artery were seen in multidetector computed tomographic pulmonary angiography with normal blood pressure and echocardiographic right ventricular overload. And we found a pulmonary artery clot in the right pulmonary artery through transthoracic echocardiography. After 11-days anticoagulation, the patient underwent a reassessment, showed decrease in RV diameter and pulmonary artery thrombus. ConclusionThis case highlights the significant role that echocardiography played in a patient who presented pulmonary embolism with a stable hemodynamic situation and normal blood pressure. The new echocardiographic view could provide correct diagnoses by identifying the clot size and location visually. Knowledge of the echocardiography results of APE would aid the diagnosis.

scholarly journals Pulmonary Embolism after Knee Arthroscopy in 57-Year-Old Woman

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0019
Author(s):  
Ahmet Adnan Karaarslan ◽  
Sevinç Varol ◽  
Tolga Karcı ◽  
Hakan Aycan ◽  
Erhan Sesli
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Knee Pain ◽  
Knee Arthroscopy ◽  
Epigastric Pain ◽  
Pulmonary Angiography ◽  
Pneumatic Tourniquet ◽  
Acute Gastritis ◽  
Arthroscopic Meniscectomy ◽  
The Right

Objectives: Pulmonary embolism (PE) after knee arthroscopy is even a rare occurrence in older patients. In this report, we present an unusual case of PE following knee arthroscopy. Methods: A 57-year-old woman normally active patient presented to the orthopaedic clinic has been suffering a right knee pain responseless to the medical treatment for a year. Hystory was unremarkable with the exception of hypertension and cervical biopsy. Results: An arthroscopic meniscectomy was received under spinal anesthesia after the application of an Esmarch and pneumatic tourniquet. Post-operatively first day, she was discharged. While transporting, she developed dyspnea, weakness and low-right breast pain. An immediate pulmonary angiography and cardiac echograpy demonsrated the obstruction in the right common pulmonary artery and subsegmentary occlutions in the left side. Conclusion: After a 24-hour streptokinase therapy(ST), coumadine was started. Near the end of ST, she complained a severe knee pain healed by the punctures. Because of a severe epigastric pain unable to control by gastric prophilaxy and therapy.The patient was consulted by a gastroenterology specialist and gastric endoscopy showed an acute gastritis. A control pulmonary angiography on eighth day demonstrated no thrombus including right common pulmonary artery. The patient was successfully discharged on the 11th day.

scholarly journals Characteristics of Acute Pulmonary Embolism in Patients With COVID-19 Associated Pneumonia From the City of Wuhan

2020 ◽  
Vol 26 ◽  
pp. 107602962093677 ◽  
Author(s):  
Jianpu Chen ◽  
Xiang Wang ◽  
Shutong Zhang ◽  
Bin Lin ◽  
Xiaoqing Wu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Laboratory Data ◽  
Lower Lobe ◽  
Middle Lobe ◽  
Imaging Characteristics ◽  
Right Middle Lobe ◽  
The Right ◽  
D Dimer

The aim of this study was to describe clinical, imaging, and laboratory features of acute pulmonary embolism (APE) in patients with COVID-19 associated pneumonia. Patients with COVID-19 associated pneumonia who underwent a computed tomography pulmonary artery (CTPA) scan for suspected APE were retrospectively studied. Laboratory data and CTPA images were collected. Imaging characteristics were analyzed descriptively. Laboratory data were analyzed and compared between patients with and without APE. A series of 25 COVID-19 patients who underwent CTPA between January 2020 and February 2020 were enrolled. The median D-dimer level founded in these 25 patients was 6.06 μg/mL (interquartile range [IQR] 1.90-14.31 μg/mL). Ten (40%) patients with APE had a significantly higher level of D-dimer (median, 11.07 μg/mL; IQR, 7.12-21.66 vs median, 2.44 μg/mL; IQR, 1.68-8.34, respectively, P = .003), compared with the 15 (60%) patients without APE. No significant differences in other laboratory data were found between patients with and without APE. Among the 10 patients with APE, 6 (60%) had a bilateral pulmonary embolism, while 4 had a unilateral embolism. The thrombus-prone sites were the right lower lobe (70%), the left upper lobe (60%), both upper lobe (40%) and the right middle lobe (20%). The thrombus was partially or completely absorbed after anticoagulant therapy in 3 patients who underwent a follow-up CTPA. Patients with COVID-19 associated pneumonia have a risk of developing APE during the disease. When the D-dimer level abnormally increases in patients with COVID-19 pneumonia, CTPA should be performed to detect and assess the severity of APE.

Incidence and Management of Isolated Subsegmental Pulmonary Embolism.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2989-2989
Author(s):  
Yi-Hao Shen ◽  
Phil Wells ◽  
Carole Dennie ◽  
Marc Carrier
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Clinical Management ◽  
High Probability ◽  
Conflicts Of Interest ◽  
Anticoagulation Therapy ◽  
Pulmonary Arteries ◽  
Filling Defect ◽  
Pulmonary Angiography ◽  
Acute Pe

Abstract Abstract 2989 Poster Board II-965 Introduction: The use of computed tomographic pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) has improved the visualization of subsegmental pulmonary arteries. However, the clinical significance of subsegmental PE is unclear. In the PIOPED Study, PE limited to subsegmental pulmonary arteries was most prevalent among patients with low-probability ventilation/perfusion (V/Q) scans. Patients with non-diagnostic (low or intermediate) V/Q scans can be safely managed without anticoagulation. The incidence and clinical management of subsegmental PE remains uncertain. Objective: To evaluate the incidence and clinical management of subsegmental PE in patients with suspected acute PE. Methods: This is a retrospective cohort study of consecutive patients with suspected acute PE undergoing CTPA at the Ottawa Hospital from Jan 1, 2007 to Dec 31, 2008. Subsegmental PE was defined as one or more pulmonary artery filling defects located in the subsegmental level, with no filling defects visualized at more proximal pulmonary artery levels. All patients were followed for a minimum of 6 months after the index PE. Results: A total of 78 (10.4%, 95% CI: 8.4 to 12.8%) cases of subsegmental PE were identified out of 748 cases of PE diagnosed by CTPA. Forty-three (77%) of these had a single isolated subsegmental filling defect. Data could be extracted in 56 (72%) of the 78 cases. Among these 56 patients, 18 (32%) had unprovoked PE. Further investigations were performed in 50 patients (Ultrasonography (U/S) of legs (n=38), U/S and V/Q scan (n=11) or V/Q scan alone (n=1)). Deep vein thrombosis was detected in 12 patients and two patients had a high probability V/Q scan. Forty-eight (86%) patients were anticoagulated. All patients with concurrent DVT or high probability V/Q scan were started on anticoagulation therapy. Two patients experienced a major bleeding episode after anticoagulation. Out of the 8 patients left untreated, there were no recurrent VTE. Conclusion: Isolated subsegmental PE represents approximately 10% of all acute PE diagnosed by CTPA. Patients with subsegmental PE diagnosed on CTPA are more commonly receiving anticoagulation than not. Further studies are needed to establish the risk benefit ratio of anticoagulation therapy in patients with subsegmental PE diagnosed on CTPA. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries

2019 ◽  
Vol 45 (1) ◽  
Author(s):  
Alexandre Dias Mançano ◽  
Rosana Souza Rodrigues ◽  
Miriam Menna Barreto ◽  
Gláucia Zanetti ◽  
Thiago Cândido de Moraes ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Computed Tomography Angiography ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Lower Lobe ◽  
Pulmonary Infarction ◽  
Halo Sign ◽  
Reversed Halo Sign ◽  
The Right

ABSTRACT Objective: To determine the incidence of the reversed halo sign (RHS) in patients with pulmonary infarction (PI) due to acute pulmonary embolism (PE), detected by computed tomography angiography (CTA) of the pulmonary arteries, and to describe the main morphological features of the RHS. Methods: We evaluated 993 CTA scans, stratified by the risk of PE, performed between January of 2010 and December of 2014. Although PE was detected in 164 scans (16.5%), three of those scans were excluded because of respiratory motion artifacts. Of the remaining 161 scans, 75 (46.6%) showed lesions consistent with PI, totaling 86 lesions. Among those lesions, the RHS was seen in 33 (38.4%, in 29 patients). Results: Among the 29 patients with scans showing lesions characteristic of PI with the RHS, 25 (86.2%) had a single lesion and 4 (13.8%) had two, totaling 33 lesions. In all cases, the RHS was in a subpleural location. To standardize the analysis, all images were interpreted in the axial plane. Among those 33 lesions, the RHS was in the right lower lobe in 17 (51.5%), in the left lower lobe in 10 (30.3%), in the lingula in 5 (15.2%), and in the right upper lobe in 1 (3.0%). Among those same 33 lesions, areas of low attenuation were seen in 29 (87.9%). The RHS was oval in 24 (72.7%) of the cases and round in 9 (27.3%). Pleural effusion was seen in 21 (72.4%) of the 29 patients with PI and the RHS. Conclusions: A diagnosis of PE should be considered when there are findings such as those described here, even in patients with nonspecific clinical symptoms.

scholarly journals Acute pulmonary embolism following endoscopic sclerotherapy for gastroesophageal variceal hemorrhage: A case report and literature review

2019 ◽  
Vol 7 ◽  
pp. 2050313X1983894 ◽  
Author(s):  
Nuanrat Tangcheewinsirikul ◽  
Chusana Suankratay
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Alcoholic Cirrhosis ◽  
Final Diagnosis ◽  
Endoscopic Sclerotherapy ◽  
Variceal Hemorrhage ◽  
Anticoagulant Treatment ◽  
Progressive Dyspnea ◽  
The Right

Gastroesophageal variceal hemorrhage is a substantial cause of death in patients with portal hypertension. Cyanoacrylate injection is a widely used endoscopic treatment for variceal hemorrhage. We report herein the case of a 49-year-old male with decompensated alcoholic cirrhosis, who received endoscopic sclerotherapy to stop gastroesophageal variceal hemorrhage during hospitalization. The following day, he developed acute progressive dyspnea, and computed tomogram of pulmonary artery revealed acute pulmonary embolism at the right lower pulmonary artery. A final diagnosis of sclerotherapy-associated pulmonary embolism was made, and he gradually improved conservatively without anticoagulant treatment 2 weeks after hospitalization.

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