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Weldetsadik AY, Kebede A, Godu BG, Gama M. Unilateral pulmonary vein atresia presenting with recurrent hemoptysis and bronchial varices in an Ethiopian adolescent: a case report. J Med Case Rep 2023; 17:246. [PMID: 37269023 DOI: 10.1186/s13256-023-03956-4] [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: 12/14/2021] [Accepted: 04/27/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Congenital unilateral pulmonary vein atresia is a rare anomaly resulting from failure of the pulmonary vein to incorporate in the left atrium. It is a very rare cause of recurrent respiratory infections and hemoptysis requiring a high index of suspicion for proper diagnosis and management in early childhood. CASE PRESENTATION We report a 13-year old Anuac (Ethiopia, Region of Gambela) male adolescent with a delayed diagnosis of isolated atresia of the left pulmonary veins despite early childhood presentation with recurrent chest infections, hemoptysis and exercise intolerance. Contrast enhanced CT of thorax with reconstructed planes confirmed the diagnosis. He underwent pneumonectomy for severe and recurrent symptoms and did well on subsequent follow ups after 6 months of pneumonectomy. CONCLUSION Although a rare anomaly, congenital unilateral pulmonary vein atresia should be considered in the differential diagnosis of a child presenting with recurrent chest infections, exercise intolerance and hemoptysis to facilitate early appropriate diagnosis and treatment.
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Affiliation(s)
| | - Abdi Kebede
- Department of Pediatrics and Child Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Binyam Gebremedhin Godu
- Pediatric Surgery Unit, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Maru Gama
- Department of Surgery, Pediatric Surgery Unit, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Aggarwal V, Stapleton GE, Eilers LF, Gowda S, Bansal M, Qureshi AM, Webb MK, Khan A, Justino H. Pulmonary Vein Atresia: Feasibility of Initial Recanalization Attempts with Subsequent Follow-up. Curr Probl Cardiol 2023; 48:101463. [PMID: 36261100 DOI: 10.1016/j.cpcardiol.2022.101463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023]
Abstract
Pulmonary vein atresia (PVA) may lead to pulmonary hypertension, cardiac failure, and death. Transcatheter or surgical treatments have rarely been offered to this population because of perceived poor outcomes. We describe single center outcomes of transcatheter management of PVA. Retrospective chart review of PVA patients who underwent cardiac catheterization at a single tertiary center. Sixty patients underwent catheterization for evaluation of PVA from 1995 to 2019. The age at the initial catheterization was 1.6 (0.7, 5.97) years. Two thirds of PVA patients had associated congenital heart disease (n=40). PVA recanalization was attempted in 34 patients, successful in 23/34 (68%) of the initial attempts. 3/23 (13%) underwent balloon angioplasty alone, and 20/23 (87%) received drug-eluting stents, with no procedural mortalities. 22/23 patients had transcatheter reinterventions during an interval of 2.1 (0.3, 5.1) years. Right ventricular systolic to aortic systolic pressure ratio (in biventricular patients) at the index catheterization was 0.45 (0.34, 0.68) in survivors versus 0.69 (0.54, 0.83) in those who died; P = 0.012 (n=45). The baseline right ventricular or pulmonary artery systolic to aortic systolic pressure ratio of ≥0.54 at the initial catheterization was predictive of mortality. We hereby demonstrate that transcatheter recanalization of PVA with placement of drug-eluting stents can be performed safely with acceptable success rate. With appropriate use of re-interventions for restenosis as indicated, PVA can be successfully palliated with good long-term patency and distal growth of the affected veins. Pulmonary hypertension is a risk factor for mortality in patients with PVA and biventricular circulation. Percutaneous recanalization of PVA is safe and feasible, and with placement of drug-eluting stents, carries a high acute success rate and results in growth of the distal pulmonary veins. However, close vigilance and reinterventions are required due to restenosis.
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Affiliation(s)
- Varun Aggarwal
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Gary E Stapleton
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Lindsay F Eilers
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Srinath Gowda
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Manish Bansal
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Athar M Qureshi
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Melissa K Webb
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Asra Khan
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Henri Justino
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
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Wong YS, Abidin ZZ, Musa AN, Kadir RFA, Johari B. Unilateral pulmonary artery agenesis: An unusual cause of hemoptysis. Respir Med Case Rep 2023; 43:101834. [PMID: 36950023 PMCID: PMC10025273 DOI: 10.1016/j.rmcr.2023.101834] [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: 02/18/2023] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Introduction Unilateral pulmonary artery agenesis (UPAA) is a rare congenital malformation of the pulmonary artery due to agenesis of the sixth aortic arch during embryogenesis. Diagnosis can be challenging due to variable clinical presentations. Case A 29-year-old female at third trimester of twin pregnancy presented with massive hemoptysis. Computed tomography angiogram (CTA) showed unilateral absence of the right pulmonary artery with multiple dilated tortuous bronchial arteries supplying the right lung. Selective embolization of the bronchial artery was performed post-partum. Conclusion Clinicians should have a high clinical suspicion of collateral artery bleeding in patients who present with unexplained hemoptysis and typical UPAA radiographic findings.
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Affiliation(s)
- Yen Shen Wong
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
- Corresponding author.
| | | | | | | | - Bushra Johari
- Department of Radiology, Universiti Teknologi MARA, Sungai Buloh, Malaysia
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Romberg EK, Stanescu AL, Bhutta ST, Otto RK, Ferguson MR. Computed tomography of pulmonary veins: review of congenital and acquired pathologies. Pediatr Radiol 2022; 52:2510-2528. [PMID: 34734315 DOI: 10.1007/s00247-021-05208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/26/2021] [Accepted: 09/10/2021] [Indexed: 10/19/2022]
Abstract
Newer-generation CT scanners with ultrawide detectors or dual sources offer millisecond image acquisition times and significantly decreased radiation doses compared to historical cardiac CT and CT angiography. This technology is capable of nearly freezing cardiac and respiratory motion. As a result, CT is increasingly used for diagnosing and monitoring cardiac and vascular abnormalities in the pediatric population. CT is particularly useful in the setting of pulmonary vein evaluation because it offers evaluation of the entire pulmonary venous system and lung parenchyma. In this article we review a spectrum of congenital and acquired pulmonary venous abnormalities, including potential etiologies, CT imaging findings and important factors of preoperative planning. In addition, we discuss optimization of CT techniques for evaluating the pulmonary veins.
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Affiliation(s)
- Erin K Romberg
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - A Luana Stanescu
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Sadaf T Bhutta
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Randolph K Otto
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Mark R Ferguson
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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Lee EY, Jenkins KJ, Vargas SO, Callahan R, Park HJ, Gauthier Z, Winant AJ. Thoracic Multidetector Computed Tomography Angiography of Primary Pulmonary Vein Stenosis in Children: Evaluation of Characteristic Extravascular Findings. J Thorac Imaging 2021; 36:318-325. [PMID: 33999569 DOI: 10.1097/rti.0000000000000590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the extravascular thoracic multidetector computed tomography (MDCT) angiography findings of pediatric primary pulmonary vein stenosis (PVS) by comparing extravascular thoracic MDCT angiography findings in children with and without PVS. MATERIALS AND METHODS All pediatric patients (age 18 y and below) with a known diagnosis of primary PVS, confirmed by echocardiogram and/or conventional angiography, who underwent thoracic MDCT angiography studies from July 2006 to December 2020 were included. A comparison group, comprised of age-matched and sex-matched pediatric patients without PVS who underwent thoracic MDCT angiography studies during the same study period, was also generated. Two pediatric radiologists independently evaluated thoracic MDCT angiography studies for the presence of extravascular thoracic abnormalities in the lung (ground-glass opacity [GGO], consolidation, pulmonary nodule, mass, cyst, septal thickening, fibrosis, and bronchiectasis), pleura (pleural thickening, pleural effusion and pneumothorax), and mediastinum (lymphadenopathy and mass). When a thoracic abnormality was identified, the location and distribution of the abnormality (in relation to the location of PVS) were also evaluated. Extravascular thoracic MDCT angiography findings of pediatric patients with and without primary PVS were compared. Interobserver agreement between the 2 independent reviewers was evaluated with κ statistics. RESULTS The study group consisted of 15 thoracic MDCT angiography studies from 15 individual pediatric patients with primary PVS (8 males [53%] and 7 females [47%]; mean age: 10.9 mo; SD: 11.7 mo; range: 1 to 48 mo). The comparison group consisted of 15 thoracic MDCT angiography studies from 15 individual pediatric patients without PVS (8 males [53%] and 7 females [47%]; mean age: 10.2 mo; SD: 11.5 mo; range: 1 to 48 mo). In children with primary PVS, the characteristic extravascular thoracic MDCT angiography findings were GGO (14/15; 93%), septal thickening (5/15; 33%), pleural thickening (14/15; 93%), and ill-defined, mildly heterogeneously enhancing, noncalcified soft tissue mass (14/15; 93%) following the contours of PVS in the mediastinum. There was excellent interobserver κ agreement between 2 independent reviewers for detecting extravascular abnormalities on thoracic MDCT angiography studies (κ=0.99 for the study group and κ=0.98 for the comparison group). CONCLUSIONS Children with primary PVS have characteristic extravascular thoracic MDCT angiography findings. In the lungs and pleura, GGO, septal thickening, and pleural thickening are common findings. Importantly, in the mediastinum, the presence of a mildly heterogeneously enhancing, noncalcified soft tissue mass in the distribution of PVS is a novel characteristic thoracic MDCT angiography finding unique to pediatric primary PVS. When this constellation of extravascular thoracic MDCT angiography findings is detected, although rare, primary PVS should be considered as a possible underlying diagnosis, especially in symptomatic children.
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Affiliation(s)
| | | | - Sara O Vargas
- Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
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Extravascular MDCT Findings of Pulmonary Vein Stenosis in Children with Cardiac Septal Defect. CHILDREN-BASEL 2021; 8:children8080667. [PMID: 34438558 PMCID: PMC8394993 DOI: 10.3390/children8080667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/14/2021] [Accepted: 07/22/2021] [Indexed: 01/01/2023]
Abstract
Purpose: To retrospectively investigate the extravascular thoracic MDCT angiography findings of pulmonary vein stenosis (PVS) in children with a cardiac septal defect. Materials and Methods: Pediatric patients (age ≤ 18 years) with cardiac septal defect and PVS, confirmed by echocardiogram and/or conventional angiography, who underwent thoracic MDCT angiography studies from April 2009 to April 2021 were included. Two pediatric radiologists independently evaluated thoracic MDCT angiography studies for the presence of extravascular thoracic abnormalities in: (1) lung and airway (ground-glass opacity (GGO), consolidation, pulmonary nodule, mass, cyst, septal thickening, fibrosis, and bronchiectasis); (2) pleura (pleural thickening, pleural effusion, and pneumothorax); and (3) mediastinum (mass and lymphadenopathy). Interobserver agreement between the two independent pediatric radiology reviewers was evaluated with kappa statistics. Results: The final study group consisted of 20 thoracic MDCT angiography studies from 20 consecutive individual pediatric patients (13 males (65%) and 7 females (35%); mean age: 7.5 months; SD: 12.7; range: 2 days to 7 months) with cardiac septal defect and PVS. The characteristic extravascular thoracic MDCT angiography findings were GGO (18/20; 90%), septal thickening (9/20; 45%), pleural thickening (16/20; 80%), and ill-defined, mildly heterogeneously enhancing, non-calcified soft tissue mass (9/20; 45%) following the contours of PVS in the mediastinum. There was a high interobserver kappa agreement between two independent reviewers for detecting extravascular abnormalities on thoracic MDCT angiography studies (k = 0.99). Conclusion: PVS in children with a cardiac septal defect has a characteristic extravascular thoracic MDCT angiography finding. In the lungs and pleura, GGO, septal thickening, and pleural thickening are frequently seen in children with cardiac septal defect and PVS. In the mediastinum, a mildly heterogeneously enhancing, non-calcified soft tissue mass in the distribution of PVS in the mediastinum is seen in close to half of the pediatric patients with cardiac septal defect and PVS.
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Liu Z, Zhang M, Huo Q, Zhu T. Changes in ET-1, Plasma Neuropeptide Y, and CGRP in Child Patients With Congenital Heart Disease Complicated With Pulmonary Hypertension Before and After Operation. Clin Pediatr (Phila) 2021; 60:56-63. [PMID: 32814460 DOI: 10.1177/0009922820948261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study aims to explore the changes in endothelin-1 (ET-1), plasma neuropeptide Y, and calcitonin gene-related peptide (CGRP) in child patients before and after operation. A total of 80 child patients with congenital heart disease (CHD) complicated with pulmonary hypertension (PH) were enrolled and divided into control group (n = 40, conservative treatment for various reasons) and observation group (n = 40, active preoperative preparation and timely operative intervention) according to different treatments. There were positive correlations between systolic pulmonary arterial pressure (sPAP) and ET-1, plasma neuropeptide Y, while negative correlation between sPAP and CGRP. In conclusion, our data demonstrate that the levels of ET-1, plasma neuropeptide Y, and CGRP in PH-CHD were significantly changed after interventions, which provides new leads as alternative biomarkers to assess the efficacy of treatments against PH-CHD.
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Affiliation(s)
- Zheng Liu
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Mingming Zhang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Qiang Huo
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Tao Zhu
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
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Okamoto R, Miyazaki O, Aoki H, Tsutsumi Y, Miyasaka M, Hoshiai M, Nosaka S. Mediastinal and hilar soft tissue mass-like lesions in congenital unilateral pulmonary vein atresia: A retrospective review of seven pediatric patients. Pediatr Int 2020; 62:1234-1240. [PMID: 32428316 DOI: 10.1111/ped.14307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 04/04/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital unilateral pulmonary vein atresia (CUPVA) is known to lead to the formation of an abnormal confluent mediastinal and hilar soft tissue mass, thoracic hypoplasia, and interlobular septal thickening on the affected side. The purpose of the present study is to investigate the frequency and severity of mediastinal soft tissue mass-like lesions and examine other abnormal findings associated with CUPVA. METHODS We retrospectively reviewed seven children with CUPVA who underwent contrast-enhanced CT scans and measured the soft tissue mass volume in the bilateral mediastinum (affected and normal side). The location of abnormal soft tissue was divided into three anatomical sections (paratracheal, peribronchial, and the dorsal aspect of the left atrium). The relationships among soft tissue volume and anatomical section were statistically evaluated. Also, the presence of thoracic hypoplasia, small ipsilateral pulmonary arteries, interlobular septal thickening, and ground-glass opacities were investigated. RESULTS In all cases, CT scans confirmed the presence of confluent soft tissue mass-like lesions in the affected mediastinum. The soft tissue volume on the affected side was 5.5-fold greater than the volume on the normal side (average: 18.0 cm3 and 4.25 cm3 respectively, P < 0.01). Thoracic hypoplasia and interlobular septal thickening were found in all patients. Small pulmonary arteries and ground-glass opacities were present in six of the seven patients. CONCLUSION Abnormal mediastinal and hilar soft tissue is commonly found in patients with CUPVA. So, if we encounter the mediastinal soft tissue mass in patients with CUPVA, no further test will be indicated.
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Affiliation(s)
- Reiko Okamoto
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Osamu Miyazaki
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Hidekazu Aoki
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Yoshiyuki Tsutsumi
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Mikiko Miyasaka
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Minako Hoshiai
- Department of Pediatrics, Yamanashi Prefectural Central Hospital, Kofu-shi, Yamanashi-ken, Japan
| | - Shunsuke Nosaka
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
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Shah S, Deshmukh C, David JE, Hosalkar M. Unilateral pulmonary venous atresia: A rare cause of recurrent hemoptysis. Lung India 2020; 37:164-166. [PMID: 32108604 PMCID: PMC7065558 DOI: 10.4103/lungindia.lungindia_369_19] [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] [Indexed: 11/16/2022] Open
Abstract
Hemoptysis is a rare but distressing complaint in children. Pulmonary venous atresia (PVA) is a rare cause of recurrent hemoptysis in children. We report a 3-year-old boy with recurrent hemoptysis for 2 years. The child had tachycardia, tachypnea, tender hepatomegaly, and left-sided decreased air entry with crepitations. Coagulation and Koch's workup was negative. X-ray of the chest showed a small left hemithorax. Computed tomography with angiography showed left unilateral PVA with pulmonary artery hypoplasia and dysplastic left lung. The child has been posted for left pneumonectomy. Although uncommon, PVA should be diagnosed early to prevent life-threatening complications such as hemoptysis and pulmonary hypertension. The patient can be managed conservatively or surgically depending on the severity. Early diagnosis and intervention helps in reducing morbidity and mortality.
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