1
|
Yamasaki K, Iwanaga Y, Uryu T, Sato T, Kawaguchi T, Nishida C, Yatera K. Pulmonary veno-occlusive disease with vanished pulmonary consolidation. Respirol Case Rep 2023; 11:e01219. [PMID: 37711650 PMCID: PMC10498427 DOI: 10.1002/rcr2.1219] [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: 08/18/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
Pulmonary veno-occlusive disease (PVOD) is an extremely rare cause of pulmonary hypertension. Previously reported computed tomography (CT) findings of PVOD included centrilobular ground-glass opacities, a mosaic pattern, and septal lines; however, chest CT revealing pulmonary consolidation disappearance with repositioning has not been reported.
Collapse
Affiliation(s)
- Kei Yamasaki
- Department of Respiratory MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Yuto Iwanaga
- Department of Respiratory MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Takumu Uryu
- Department of Respiratory MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Tomoki Sato
- Department of Respiratory MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Takako Kawaguchi
- Department of Respiratory MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Chinatsu Nishida
- Department of Respiratory MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Kazuhiro Yatera
- Department of Respiratory MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| |
Collapse
|
2
|
Laimoud M, Alanazi Z, Alahmadi F, Aldalaan A. A Challenging Case of Genetically and Histologically Diagnosed Pulmonary Veno-Occlusive Disease with Extracorporeal Life Support and Redo Lung Transplantation. Case Rep Cardiol 2023; 2023:4846338. [PMID: 37649985 PMCID: PMC10465249 DOI: 10.1155/2023/4846338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023] Open
Abstract
Background Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary arterial hypertension characterized by diffuse venous vasculopathy and increased pulmonary vascular resistance resulting in right-sided heart failure. Case Presentation. A 22-year-old female patient started to have dyspnea with minimal effort and was diagnosed to have pre-capillary pulmonary hypertension (PH) with right-sided heart failure. Initially, she was diagnosed to have idiopathic PH. She developed life-threatening pulmonary oedema and cardiogenic shock after pulmonary vasodilator therapy. A genetic study was done and revealed the eukaryotic translation initiation factor 2 alpha kinase 4 (EIF2AK4) gene on chromosome 15, which was diagnostic to heritable PVOD. After failure to achieve hemodynamic stabilization with conventional cardiopulmonary support measures, extracorporeal membrane oxygenation (ECMO) supported her till bilateral lung transplantation, which was unfortunately complicated by acute graft rejection. After a prolonged intensive care unit stay with 4-month ECMO support, the second bilateral lung transplantation was done, and the patient survived and was discharged. Conclusions Clinical recognition of PVOD is crucial due to its challenging diagnosis, need for genetic study, rapid deterioration with pulmonary vasodilators, and bad prognosis. Lung transplantation is the definitive treatment for eligible candidates.
Collapse
Affiliation(s)
- Mohamed Laimoud
- Cardiac Surgery Critical Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Critical Care Medicine Department, Cairo University, Cairo, Egypt
| | - Ziyad Alanazi
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fayez Alahmadi
- Pulmonary Medicine Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah Aldalaan
- Pulmonary Medicine Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
In Situ Pulmonary Arterial Thrombosis-Literature Review and Clinical Significance of a Distinct Entity. AJR Am J Roentgenol 2023:1-12. [PMID: 36856299 DOI: 10.2214/ajr.23.28996] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Filling defects identified in the pulmonary arterial tree are commonly presumed to represent an embolic phenomenon originating from thrombi formed in remote veins, particularly lower-extremity deep venous thrombosis (DVT). However, accumulating evidence supports an underappreciated cause for pulmonary arterial thrombosis (PAT), namely, de novo thrombogenesis-where thrombosis arises within the pulmonary arteries in the absence of DVT. Although historically underrecognized, in situ PAT has become of heightened importance with the emergence of SARS-CoV-2 infection. In situ PAT is attributed to endothelial dysfunction, systemic inflammation, and acute lung injury, and has been described in a range of conditions including COVID-19, trauma, acute chest syndrome in sickle cell disease, pulmonary infections, and severe pulmonary arterial hypertension. The distinction between pulmonary embolus and in situ PAT may have important implications regarding management decisions and clinical outcomes. In this review, we summarize the pathophysiology, imaging appearances, and management of in situ PAT in various clinical situations. This understanding will promote optimal tailored treatment strategies for this increasingly recognized entity.
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Sirajuddin A, Mirmomen SM, Henry TS, Kandathil A, Kelly AM, King CS, Kuzniewski CT, Lai AR, Lee E, Martin MD, Mehta P, Morris MF, Raptis CA, Roberge EA, Sandler KL, Donnelly EF. ACR Appropriateness Criteria® Suspected Pulmonary Hypertension: 2022 Update. J Am Coll Radiol 2022; 19:S502-S512. [PMID: 36436973 DOI: 10.1016/j.jacr.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations may be helpful in diagnosing and determining the etiology of pulmonary hypertension. Imaging examinations discussed in this document include chest radiography, ultrasound echocardiography, ventilation/perfusion scintigraphy, CT, MRI, right heart catheterization, and pulmonary angiography. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
| | | | - Travis S Henry
- Panel Chair, University of California San Francisco, San Francisco, California; Co-Director, ACR Education Center High Resolution CT of the Chest Course; Division Chief of Cardiothoracic Imaging, Duke University
| | - Asha Kandathil
- University of Texas Southwestern Medical Center, Dallas, Texas; Associate Program Director, Cardiothoracic Radiology Fellowship, The University of Texas Southwestern Medical Center
| | - Aine Marie Kelly
- Emory University Hospital, Atlanta, Georgia; Assistant Program Director Radiology Residency
| | - Christopher S King
- Inova Fairfax Hospital, Falls Church, Virginia; American College of Chest Physicians; Associate Medical Director, Advanced Lung Disease and Transplant Program; Associate Medical Director, Pulmonary Hypertension Program; System Director, Respiratory Therapy; Pulmonary Fibrosis Foundation
| | | | - Andrew R Lai
- University of California San Francisco, San Francisco, California; Primary care physician; former Director of the University of California San Francisco Hospitalist Procedure Service; former Director of the University of California San Francisco Division of Hospital Medicine's Case Review Committee, and former Director of procedures/quality improvement rotation for for the UCSF Internal Medicince residency
| | - Elizabeth Lee
- University of Michigan Health System, Ann Arbor, Michigan; Director M1Radiology Education University of Michigan Medical School, Associated Program Director Diagnostic Radiology Michigan Medicine, Director of Residency Education Cardiothoracic Division Michigan
| | - Maria D Martin
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Director Diversity and Inclusion, Department of Radiology, University of Wisconsin School of Medicine and Public Health
| | - Parth Mehta
- University of Illinois at Chicago College of Medicine, Chicago, Illinois; American College of Physicians
| | - Michael F Morris
- University of Arizona College of Medicine, Phoenix, Arizona; Director of Cardiac CT and MRI
| | | | - Eric A Roberge
- Uniformed Services University of the Health Sciences-Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | - Kim L Sandler
- Vanderbilt University Medical Center, Nashville, Tennessee; Imaging Chair Thoracic Committee ECOG-ACRIN; Co-Chair Lung Screening 2.0 Steering Committee; Co-Director Vanderbilt Lung Screening Program
| | - Edwin F Donnelly
- Specialty Chair, The Ohio State University Wexner Medical Center, Columbus, Ohio; Ohio State University Medical Center: Chief of Thoracic Radiology, Interim Vice Chair of Academic Affairs, Department of Radiology
| |
Collapse
|
6
|
Solitary Pulmonary Capillary Hemangioma: CT and PET-CT Features with Clinicopathologic Correlation. Diagnostics (Basel) 2022; 12:diagnostics12112618. [DOI: 10.3390/diagnostics12112618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate the CT and PET-CT features of solitary pulmonary capillary hemangioma (SPCH) with clinicopathologic correlations. This retrospective study included 17 patients with histologically proven SPCH from four tertiary institutions. The clinical, pathological and imaging findings of SPCH were reviewed. The CT features assessed included lesion location, size, density, contour, margin, enhancement, presence of air bronchogram, perivascular lucency and pleural retraction, and 18F-fluorodeoxyglucose uptake on PET-CT. Changes in the size during the follow-up period were also evaluated. Imaging features were correlated with the clinicopathologic findings. The mean age of the patients was 47 years (range 30–60 years). All SPCHs were incidentally detected during screening CT examinations (n = 13, 76%) or during cancer work-up (n = 4, 24%). Most SPCHs appeared as part-solid nodules (n = 15, 88%), the remaining appeared as a pure ground-glass nodule or a pure solid nodule, respectively. Most had smooth contours (n = 16, 94%), while one had a lobulated contour. Nine SPCHs (53%) showed ill-defined margins. Air bronchogram was present in ten (59%) SPCHs, and perivascular lucency in two (12%). All SPCHs exhibited hypoattenuation on contrast-enhanced CT and hypometabolism on PET-CT. During the follow-up period (mean 14.8 ± 17.7 months), the lesions showed no change in size or density in ten SPCHs (59%), decreased or fluctuation in size and density in three (18%). SPCH is often incidentally detected in young and middle-aged adults, commonly as an ill-defined part-solid nodule that may accompany air bronchogram, perivascular lucency, and fluctuation in size or density on CT and hypometabolism on PET-CT.
Collapse
|
7
|
Kanamoto Y, Dejima H, Saito Y, Haga T, Watanabe T, Yamauchi Y, Sasajima Y, Saito K, Kawamura M, Sakao Y. Solitary pulmonary capillary hemangioma mimicking a preinvasive malignant lesion in an asymptomatic middle-aged female patient. Int Cancer Conf J 2022; 12:14-18. [PMID: 36605833 PMCID: PMC9807707 DOI: 10.1007/s13691-022-00570-x] [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: 01/26/2022] [Accepted: 07/22/2022] [Indexed: 01/09/2023] Open
Abstract
Pulmonary capillary hemangiomatosis (PCH) is a rare disease characterized by a proliferation of capillaries in the alveolar septa, bronchial and venous walls, pleura, and regional lymph nodes. However, the etiology of the disease remains unknown due to its rarity. Therefore, we present a case of a solitary PCH lesion without symptoms in a 38-year-old female patient. According to computed tomography, she was diagnosed with lung carcinoma, indicated by a tiny nodule with ground-glass opacity detected in her right upper lung. However, no other lesions were detected on systemic examination. Consequently, partial lung resection was conducted, since the lesion was suspected of lung adenocarcinoma. Pathologic results showed that the thick alveolar septa were caused by capillary growth without cellular atypia and hardly any infiltration of inflammatory cells. Finally, we diagnosed the pulmonary lesion as PCH, although solitary PCH has previously been reported in a few case reports. Therefore, further case studies are essential to clarify the causes of PCH.
Collapse
Affiliation(s)
- Yasuyuki Kanamoto
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Hitoshi Dejima
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan ,grid.412305.10000 0004 1769 1397Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Yuichi Saito
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Toshihiro Haga
- grid.412305.10000 0004 1769 1397Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Tomohiro Watanabe
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Yoshikane Yamauchi
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Yuko Sasajima
- grid.412305.10000 0004 1769 1397Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Koji Saito
- grid.412305.10000 0004 1769 1397Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Masafumi Kawamura
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Yukinori Sakao
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| |
Collapse
|
8
|
Mohite K, Sapare A. Genetic cause of pulmonary veno-occlusive disease. Lung India 2022; 39:191-194. [PMID: 35259804 PMCID: PMC9053931 DOI: 10.4103/lungindia.lungindia_252_21] [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: 11/30/2022] Open
Abstract
Pulmonary veno-occlusive disease (PVOD) is an important cause of pulmonary arterial hypertension (PAH) and is classified under idiopathic cause of PAH. Over a period of time, PVOD has been studied in detail in the western countries and various diagnostic criteria are formulated. Being a rapidly progressive disease, early diagnosis is of utmost importance which helps to initiate appropriate treatment. Recent studies suggest that PVOD has a genetic predisposition and has an autosomal recessive pattern of inheritance. Here, we discuss the case of siblings diagnosed with PVOD to have such genetic predisposition for this disease.
Collapse
|
9
|
Case 1-2021: A 10-Year-Old Male With Respiratory Failure, Pleural Effusions, and Renal Failure 60 Days After Hematopoietic Stem Cell Transplant. Pediatr Crit Care Med 2021; 22:e524-e531. [PMID: 34605789 DOI: 10.1097/pcc.0000000000002792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Kunadu A, Stalls JS, Labuschagne H, Thayyil A, Falls R, Maddipati V. Mitomycin induced pulmonary veno-occlusive disease. Respir Med Case Rep 2021; 34:101437. [PMID: 34401312 PMCID: PMC8348923 DOI: 10.1016/j.rmcr.2021.101437] [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: 01/31/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022] Open
Abstract
Pulmonary veno-occlusive disease (PVOD) is a rare but devastating cause of pulmonary hypertension (PH) characterized by preferential remodeling of the pulmonary venules. Mitomycin-C (MMC) is an alkylating agent commonly used in chemotherapy with documented lung toxicity as well as PVOD adverse effect. The incidence of PVOD in patients with anal cancer is much higher than in those with idiopathic PVOD, especially following treatment with MMC. An accurate diagnosis of PVOD can be made based on noninvasive investigations utilizing oxygen parameters, low diffusing capacity for carbon monoxide and characteristic signs on high-resolution computed tomography of the chest. No evidence-based medical therapy exists for PVOD at present and lung transplant remains the preferred definitive therapy for eligible patients. We present a case of autopsy confirmed MMC induced PVOD in a patient with metastatic anal cancer.
Collapse
Affiliation(s)
- Afua Kunadu
- Division of Pulmonary, Critical Care and Sleep Medicine, USA
| | - J Stephen Stalls
- Department of Pathology, East Carolina University, Greenville, North Carolina 27858, USA
| | | | - Abdullah Thayyil
- Department of Pathology, East Carolina University, Greenville, North Carolina 27858, USA
| | - Randall Falls
- Department of Pathology, East Carolina University, Greenville, North Carolina 27858, USA
| | | |
Collapse
|
11
|
He Q, Sun Z, Li Y, Wang W, Wang RK. Spatiotemporal monitoring of changes in oxy/deoxy-hemoglobin concentration and blood pulsation on human skin using smartphone-enabled remote multispectral photoplethysmography. BIOMEDICAL OPTICS EXPRESS 2021; 12:2919-2937. [PMID: 34168907 PMCID: PMC8194624 DOI: 10.1364/boe.423160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 06/13/2023]
Abstract
We propose a smartphone-enabled remote multispectral photoplethysmography (SP-rmPPG) system and method to realize spatiotemporal monitoring of perfusion changes and pulsations of the oxyhemoglobin (HbO2) and deoxyhemoglobin (Hb) information of the effective blood volume within light interrogated skin tissue beds. The system is implemented on an unmodified smartphone utilizing its built-in camera and flashlight to acquire videos of the skin reflectance. The SP-rmPPG method converts the RGB video into multispectral cubes, upon which to decouple the dynamic changes in HbO2 and Hb information using a modified Beer-Lambert law and the selective wavelength bands of 500 nm and 650 nm. Blood pulsation amplitudes are then obtained by applying a window-based lock-in amplification on the derived spatiotemporal changes in HbO2 or Hb signals. To demonstrate the feasibility of proposed method, we conduct two experiments on the skin tissue beds that are conditioned by occlusive maneuver of supplying arteries: one using the popular blood cuff pressure maneuver on the upper arm, and another artificially inducing a transient ischemic condition on the facial skin tissue beds by finger pressing on the supplying external carotid artery. The cuff experiment shows that the measured dynamic information of HbO2 and Hb in the downstream agrees well with the parallel measurements of oxygenation saturation given by the standard pulse oximeter. We also observe the expected imbalance of spatiotemporal changes in the HbO2 and Hb between the right and left cheeks when the transient ischemic condition is induced in the one side of facial skin tissue beds. The results from the two experiments sufficiently demonstrate the feasibility of the proposed method to monitor the spatiotemporal changes in the skin hemodynamics, including blood oxygenation and pulsation amplitudes. Considering the ever-growing accessibility and affordability of the smartphone to the general public, the proposed strategy promises the early screening of vascular diseases and improving general public health particularly in rural areas with low resource settings.
Collapse
Affiliation(s)
- Qinghua He
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Zhiyuan Sun
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Yuandong Li
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Wendy Wang
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
- Department of Ophthalmology, University of Washington, Seattle, WA98105, USA
| |
Collapse
|
12
|
Homsy E, Smith S. A 26-Year-Old Woman With Dyspnea on Exertion. Chest 2021; 159:e257-e260. [PMID: 34022029 DOI: 10.1016/j.chest.2020.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/27/2020] [Accepted: 10/12/2020] [Indexed: 10/21/2022] Open
Abstract
CASE PRESENTATION A 26-year-old woman with no significant medical history was referred for 5 months of dry cough, dyspnea, presyncope and chest pressure, and nausea with exertion. The family history was notable for thromboembolic disease in the setting of malignancy and autoimmune disease. She was not on any medications. She is a never smoker and did not use recreational drugs. She had no work-related exposures. Her BP was 95/67 mm Hg; her heart rate was 93 beats per minute, and oxygen saturation was 98% on room air. Lung fields were clear to auscultation. She had a prominent P2 heart sound. There was no jugular venous distension or edema. There was no clubbing, rash, or synovitis.
Collapse
Affiliation(s)
- Elie Homsy
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Shaun Smith
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| |
Collapse
|
13
|
Micronodular lung disease on high-resolution CT: patterns and differential diagnosis. Clin Radiol 2021; 76:399-406. [PMID: 33563413 DOI: 10.1016/j.crad.2020.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
With the advent of high-resolution computed tomography (HRCT), micronodular lung disease is a routinely encountered pathology in thoracic imaging. This article will review how to differentiate the three main micronodular patterns and review the differential diagnosis for each. Differential diagnosis of micronodular lung disease may be extensive, but by identifying the pattern and using additional clues, such as distribution, additional imaging findings, and clinical history, a radiologist can make an accurate diagnosis. First, three micronodular patterns - centrilobular, peri-lymphatic, and random - can be identified by using a simple algorithm based on the location of nodules. This algorithm requires understanding of the anatomy and function of the secondary pulmonary lobule. Each micronodular pattern offers a unique differential diagnosis. Centrilobular nodules can be seen with inflammatory, infectious, or vascular aetiologies; peri-lymphatic nodules with sarcoidosis and lymphangitic carcinomatosis; and random nodules with haematogenous metastases or infections.
Collapse
|
14
|
Rapidly Progressive Respiratory Failure in Patient With Late Onset Pulmonary Capillary Hemangiomatosis. Am J Ther 2021; 28:e141-e143. [PMID: 33369913 DOI: 10.1097/mjt.0000000000000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Omori T, Nakamori S, Ohta-Ogo K, Matsuda A, Ogihara Y, Yamada N, Imanaka-Yoshida K, Ito M, Dohi K. Autopsy study of pulmonary capillary hemangiomatosis with inflammatory cell infiltration into the myocardium. Pulm Circ 2020; 10:2045894020960600. [PMID: 33282187 PMCID: PMC7686619 DOI: 10.1177/2045894020960600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/26/2020] [Indexed: 11/17/2022] Open
Abstract
Pulmonary capillary hemangiomatosis is a rare form of pulmonary artery hypertension; to date, only few descriptions of myocardial pathology in pulmonary capillary hemangiomatosis have been reported in the literature. We report the case of a Japanese female patient who was diagnosed with pulmonary capillary hemangiomatosis combined with acute myocardial inflammation on performing autopsy. She was admitted to our hospital because of acute pneumonia and subsequently suddenly developed severe hypoxemia with breathing difficulty and died 13 days after admission. At autopsy, the histology of the lung was consistent with pulmonary capillary hemangiomatosis. Additionally, a diffuse severe infiltration of inflammatory cells was associated with edema in the myocardium. Myocytolysis was limited and fibrosis was absent. To the best of our knowledge, pulmonary capillary hemangiomatosis with acute myocarditis-like histological findings has been described for the first time through our case.
Collapse
Affiliation(s)
- Taku Omori
- Department of Cardiology and Nephrology, Mie University Hospital, Tsu, Japan
| | - Shiro Nakamori
- Department of Cardiology and Nephrology, Mie University Hospital, Tsu, Japan
| | - Keiko Ohta-Ogo
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akimasa Matsuda
- Department of Cardiology and Nephrology, Mie University Hospital, Tsu, Japan.,Hakusan Clinic, Tsu, Japan
| | - Yoshito Ogihara
- Department of Cardiology and Nephrology, Mie University Hospital, Tsu, Japan
| | - Norikazu Yamada
- Department of Cardiology and Nephrology, Mie University Hospital, Tsu, Japan.,Department of Cardiology, Kuwana City Medical Center, Kuwana, Japan
| | - Kyoko Imanaka-Yoshida
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Tsu, Japan.,Mie University Research Center for Matrix Biology, Tsu, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Hospital, Tsu, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Hospital, Tsu, Japan
| |
Collapse
|
16
|
Durhan G, Ardalı Düzgün S, Başaran Demirkazık F, Irmak İ, İdilman İ, Akpınar MG, Akpınar E, Öcal S, Telli G, Topeli A, Arıyürek OM. Visual and software-based quantitative chest CT assessment of COVID-19: correlation with clinical findings. Diagn Interv Radiol 2020; 26:557-564. [PMID: 32876569 PMCID: PMC7664745 DOI: 10.5152/dir.2020.20407] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/20/2020] [Accepted: 08/04/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this study was to evaluate visual and software-based quantitative assessment of parenchymal changes and normal lung parenchyma in patients with coronavirus disease 2019 (COVID-19) pneumonia. The secondary aim of the study was to compare the radiologic findings with clinical and laboratory data. METHODS Patients with COVID-19 who underwent chest computed tomography (CT) between March 11, 2020 and April 15, 2020 were retrospectively evaluated. Clinical and laboratory findings of patients with abnormal findings on chest CT and PCR-evidence of COVID-19 infection were recorded. Visual quantitative assessment score (VQAS) was performed according to the extent of lung opacities. Software-based quantitative assessment of the normal lung parenchyma percentage (SQNLP) was automatically quantified by a deep learning software. The presence of consolidation and crazy paving pattern (CPP) was also recorded. Statistical analyses were performed to evaluate the correlation between quantitative radiologic assessments, and clinical and laboratory findings, as well as to determine the predictive utility of radiologic findings for estimating severe pneumonia and admission to intensive care unit (ICU). RESULTS A total of 90 patients were enrolled. Both VQAS and SQNLP were significantly correlated with multiple clinical parameters. While VQAS >8.5 (sensitivity, 84.2%; specificity, 80.3%) and SQNLP <82.45% (sensitivity, 83.1%; specificity, 84.2%) were related to severe pneumonia, VQAS >9.5 (sensitivity, 93.3%; specificity, 86.5%) and SQNLP <81.1% (sensitivity, 86.5%; specificity, 86.7%) were predictive of ICU admission. Both consolidation and CPP were more commonly seen in patients with severe pneumonia than patients with nonsevere pneumonia (P = 0.197 for consolidation; P < 0.001 for CPP). Moreover, the presence of CPP showed high specificity (97.2%) for severe pneumonia. CONCLUSION Both SQNLP and VQAS were significantly related to the clinical findings, highlighting their clinical utility in predicting severe pneumonia, ICU admission, length of hospital stay, and management of the disease. On the other hand, presence of CPP has high specificity for severe COVID-19 pneumonia.
Collapse
Affiliation(s)
- Gamze Durhan
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Selin Ardalı Düzgün
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Figen Başaran Demirkazık
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - İlim Irmak
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - İlkay İdilman
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Meltem Gülsün Akpınar
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Erhan Akpınar
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Serpil Öcal
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Gülçin Telli
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Arzu Topeli
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| | - Orhan Macit Arıyürek
- From the Departments of Radiology (G.D. , S.A.D., F.B.D., İ.İ., M.G.A., E.A., O.M.A.), Pulmonary Medicine (İ.I.), Intensive Care, Department of Internal Medicine, Division of Intensive Care (S.Ö., A.T.), and Infectious Diseases (G.T.), Hacettepe University School of Medicine, Ankara, Turkey
| |
Collapse
|
17
|
Oudkerk M, Büller HR, Kuijpers D, van Es N, Oudkerk SF, McLoud TC, Gommers D, van Dissel J, ten Cate H, van Beek EJ. Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands. Radiology 2020; 297:E216-E222. [PMID: 32324101 PMCID: PMC7233406 DOI: 10.1148/radiol.2020201629] [Citation(s) in RCA: 202] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A potential link between mortality, d-dimer values, and a prothrombotic syndrome has been reported in patients with coronavirus disease 2019 (COVID-19) infection. The National Institute for Public Health of the Netherlands asked a group of radiology and vascular medicine experts to provide guidance for the imaging work-up and treatment of these important complications. This report summarizes evidence for thromboembolic disease, potential diagnostic and preventive actions, and recommendations for prophylaxis and treatment of patients with COVID-19 infection.
Collapse
Affiliation(s)
- Matthijs Oudkerk
- From the Faculty of Medical Sciences, State University of Groningen, Groningen, the Netherlands (M.O.); Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (H.R.B., N.V.Es.); Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands (D.K.); Department of Radiology, Nederlands Kanker Instituut, Amsterdam, the Netherlands (S.F.O.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, U.S.A. (T.M.); Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands (D.G.); 7. National Institute of Public Health, Ministry of Health, Bilthoven, the Netherlands (J.V.D.); Department of Vascular Medicine, Maastricht University, Maastricht, the Netherlands (H.T.C.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, U.K.(E.J.R.V.B.)
| | - Harry R Büller
- From the Faculty of Medical Sciences, State University of Groningen, Groningen, the Netherlands (M.O.); Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (H.R.B., N.V.Es.); Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands (D.K.); Department of Radiology, Nederlands Kanker Instituut, Amsterdam, the Netherlands (S.F.O.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, U.S.A. (T.M.); Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands (D.G.); 7. National Institute of Public Health, Ministry of Health, Bilthoven, the Netherlands (J.V.D.); Department of Vascular Medicine, Maastricht University, Maastricht, the Netherlands (H.T.C.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, U.K.(E.J.R.V.B.)
| | - Dirkjan Kuijpers
- From the Faculty of Medical Sciences, State University of Groningen, Groningen, the Netherlands (M.O.); Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (H.R.B., N.V.Es.); Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands (D.K.); Department of Radiology, Nederlands Kanker Instituut, Amsterdam, the Netherlands (S.F.O.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, U.S.A. (T.M.); Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands (D.G.); 7. National Institute of Public Health, Ministry of Health, Bilthoven, the Netherlands (J.V.D.); Department of Vascular Medicine, Maastricht University, Maastricht, the Netherlands (H.T.C.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, U.K.(E.J.R.V.B.)
| | - Nick van Es
- From the Faculty of Medical Sciences, State University of Groningen, Groningen, the Netherlands (M.O.); Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (H.R.B., N.V.Es.); Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands (D.K.); Department of Radiology, Nederlands Kanker Instituut, Amsterdam, the Netherlands (S.F.O.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, U.S.A. (T.M.); Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands (D.G.); 7. National Institute of Public Health, Ministry of Health, Bilthoven, the Netherlands (J.V.D.); Department of Vascular Medicine, Maastricht University, Maastricht, the Netherlands (H.T.C.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, U.K.(E.J.R.V.B.)
| | - Sytse F Oudkerk
- From the Faculty of Medical Sciences, State University of Groningen, Groningen, the Netherlands (M.O.); Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (H.R.B., N.V.Es.); Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands (D.K.); Department of Radiology, Nederlands Kanker Instituut, Amsterdam, the Netherlands (S.F.O.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, U.S.A. (T.M.); Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands (D.G.); 7. National Institute of Public Health, Ministry of Health, Bilthoven, the Netherlands (J.V.D.); Department of Vascular Medicine, Maastricht University, Maastricht, the Netherlands (H.T.C.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, U.K.(E.J.R.V.B.)
| | - Theresa C McLoud
- From the Faculty of Medical Sciences, State University of Groningen, Groningen, the Netherlands (M.O.); Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (H.R.B., N.V.Es.); Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands (D.K.); Department of Radiology, Nederlands Kanker Instituut, Amsterdam, the Netherlands (S.F.O.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, U.S.A. (T.M.); Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands (D.G.); 7. National Institute of Public Health, Ministry of Health, Bilthoven, the Netherlands (J.V.D.); Department of Vascular Medicine, Maastricht University, Maastricht, the Netherlands (H.T.C.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, U.K.(E.J.R.V.B.)
| | - Diederik Gommers
- From the Faculty of Medical Sciences, State University of Groningen, Groningen, the Netherlands (M.O.); Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (H.R.B., N.V.Es.); Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands (D.K.); Department of Radiology, Nederlands Kanker Instituut, Amsterdam, the Netherlands (S.F.O.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, U.S.A. (T.M.); Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands (D.G.); 7. National Institute of Public Health, Ministry of Health, Bilthoven, the Netherlands (J.V.D.); Department of Vascular Medicine, Maastricht University, Maastricht, the Netherlands (H.T.C.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, U.K.(E.J.R.V.B.)
| | - Jaap van Dissel
- From the Faculty of Medical Sciences, State University of Groningen, Groningen, the Netherlands (M.O.); Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (H.R.B., N.V.Es.); Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands (D.K.); Department of Radiology, Nederlands Kanker Instituut, Amsterdam, the Netherlands (S.F.O.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, U.S.A. (T.M.); Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands (D.G.); 7. National Institute of Public Health, Ministry of Health, Bilthoven, the Netherlands (J.V.D.); Department of Vascular Medicine, Maastricht University, Maastricht, the Netherlands (H.T.C.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, U.K.(E.J.R.V.B.)
| | - Hugo ten Cate
- From the Faculty of Medical Sciences, State University of Groningen, Groningen, the Netherlands (M.O.); Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (H.R.B., N.V.Es.); Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands (D.K.); Department of Radiology, Nederlands Kanker Instituut, Amsterdam, the Netherlands (S.F.O.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, U.S.A. (T.M.); Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands (D.G.); 7. National Institute of Public Health, Ministry of Health, Bilthoven, the Netherlands (J.V.D.); Department of Vascular Medicine, Maastricht University, Maastricht, the Netherlands (H.T.C.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, U.K.(E.J.R.V.B.)
| | - Edwin J van Beek
- From the Faculty of Medical Sciences, State University of Groningen, Groningen, the Netherlands (M.O.); Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (H.R.B., N.V.Es.); Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands (D.K.); Department of Radiology, Nederlands Kanker Instituut, Amsterdam, the Netherlands (S.F.O.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, U.S.A. (T.M.); Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands (D.G.); 7. National Institute of Public Health, Ministry of Health, Bilthoven, the Netherlands (J.V.D.); Department of Vascular Medicine, Maastricht University, Maastricht, the Netherlands (H.T.C.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, U.K.(E.J.R.V.B.)
| |
Collapse
|
18
|
Nakamura J, Tsujino I, Yamamoto G, Nakaya T, Takahashi K, Kimura H, Sato T, Watanabe T, Nakagawa S, Otsuka N, Ohira H, Konno S. Pulmonary capillary hemangiomatosis-predominant vasculopathy in a patient with rheumatoid arthritis-associated interstitial lung disease: An autopsy report. Respir Med Case Rep 2020; 31:101215. [PMID: 33024689 PMCID: PMC7527749 DOI: 10.1016/j.rmcr.2020.101215] [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: 04/17/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Abstract
Pulmonary capillary hemangiomatosis (PCH) is a rare cause of pulmonary hypertension (PH) associated with poor prognosis. Clinically, it is characterized by severe hypoxemia, centrilobular ground-glass opacities on computed tomography, and pulmonary congestion triggered by pulmonary vasodilating therapy. In some cases, PCH has been reported to develop with other disorders including connective tissue disease; however, to date, no reports have described PCH in a patient with rheumatoid arthritis. We report a case of a 59-year-old male PCH patient with rheumatoid arthritis and associated pulmonary fibrosis. He was initially diagnosed with severe group 3 PH and received sildenafil, which generated a favorable hemodynamic response. However, 5 years later, his pulmonary hemodynamics deteriorated, and he died at the age of 67. An autopsy was performed, and thickening of alveolar septa and capillary proliferation, pathological features of PCH, were extensively observed in both lungs. We discuss when PCH developed, how sildenafil improved his hemodynamics, and how PCH could be clinically detected by noninvasive evaluations.
Collapse
Affiliation(s)
- Junichi Nakamura
- First Department of Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Ichizo Tsujino
- First Department of Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan.,Department of Cardiology, KKR Sapporo Medical Center, 3-40 1-jo, 6-chome, Toyohira-ku, Sapporo, 062-0931, Japan
| | - Gaku Yamamoto
- First Department of Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Toshitaka Nakaya
- First Department of Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Kei Takahashi
- First Department of Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Hirokazu Kimura
- First Department of Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Takahiro Sato
- Department of Cardiology, KKR Sapporo Medical Center, 3-40 1-jo, 6-chome, Toyohira-ku, Sapporo, 062-0931, Japan
| | - Taku Watanabe
- First Department of Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Shimpei Nakagawa
- Department of Pathology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Noriyuki Otsuka
- Department of Pathology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroshi Ohira
- First Department of Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Satoshi Konno
- First Department of Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| |
Collapse
|
19
|
Pulmonary capillary hemangiomatosis in Chinese patients without EIF2AK4 mutations. Pathol Res Pract 2020; 216:153100. [PMID: 32825965 DOI: 10.1016/j.prp.2020.153100] [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: 05/05/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pulmonary capillary hemangiomatosis (PCH) is a very rare and refractory pulmonary vascular disease that causes pulmonary hypertension. Differentiation of PCH from idiopathic pulmonary arterial hypertension (iPAH) is essential because treatment and prognosis can vary greatly between these two diseases. CASE PRESENTATION A 20-year-old female and a 33-year-old male both presented with progressive exertional dyspnea and cough. High-resolution computed tomography (HRCT) showed bilateral, diffuse, ill-defined centrilobular nodules of ground-glass opacity, without subpleural thickened septal lines or mediastinal lymphadenopathy. Both cases showed clinical and imaging features characteristic of pulmonary veno-occlusive disease (PVOD) or PCH. The entire EIF2AK4 coding sequence was detected with Sanger sequencing, and no pathogenic EIF2AK4 mutations were identified in either case. Video-assisted thoracoscopic surgery (VATS) was safely performed in both cases, and histopathological examinations of biopsies showed that both patients had PCH. CONCLUSION Two patients presented with clinical and imaging characteristics suspicious for PVOD/PCH. Despite having no pathogenic EIF2AK4 mutations, both were diagnosed with PCH by VATS lung biopsies. The diagnostic distinction of PCH is important to prompt timely evaluations of patients who may need lung transplantations.
Collapse
|
20
|
Moradi F, Morris TA, Hoh CK. Perfusion Scintigraphy in Diagnosis and Management of Thromboembolic Pulmonary Hypertension. Radiographics 2020; 39:169-185. [PMID: 30620694 DOI: 10.1148/rg.2019180074] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening complication of acute pulmonary embolism (PE). Because the treatment of CTEPH is markedly different from that of other types of pulmonary hypertension, lung ventilation-perfusion (V/Q) scintigraphy is recommended for the workup of patients with unexplained pulmonary hypertension. Lung V/Q scintigraphy is superior to CT pulmonary angiography for detecting CTEPH. Perfusion defect findings of CTEPH can be different from those of acute PE. Familiarity with the patterns of perfusion defects seen during the initial workup of CTEPH and the expected posttreatment changes seen at follow-up imaging is essential for accurate interpretation of V/Q scintigraphy findings. ©RSNA, 2019.
Collapse
Affiliation(s)
- Farshad Moradi
- From the Department of Radiology, Division of Nuclear Medicine (F.M., C.K.H.); and Division of Pulmonary, Critical Care, and Sleep Medicine (T.A.M.), University of California, San Diego, San Diego, Calif
| | - Timothy A Morris
- From the Department of Radiology, Division of Nuclear Medicine (F.M., C.K.H.); and Division of Pulmonary, Critical Care, and Sleep Medicine (T.A.M.), University of California, San Diego, San Diego, Calif
| | - Carl K Hoh
- From the Department of Radiology, Division of Nuclear Medicine (F.M., C.K.H.); and Division of Pulmonary, Critical Care, and Sleep Medicine (T.A.M.), University of California, San Diego, San Diego, Calif
| |
Collapse
|
21
|
Wang X, Zheng K, Racila E, Allen T. Pulmonary vein occlusion and veno-occlusive disease in a bilateral lung transplant patient: A case report. Respir Med Case Rep 2020; 30:101031. [PMID: 32257789 PMCID: PMC7097520 DOI: 10.1016/j.rmcr.2020.101031] [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: 11/23/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 11/24/2022] Open
Abstract
A pulmonary vein occlusion and biopsy proven pulmonary veno-occlusive disease (PVOD) and hemangiomatosis is found in a bilateral lung transplant patient. A 61-year-old male presents with dyspnea and chest pain with minimal exertion at routine follow up on post-transplant day of 50. Chest CT demonstrates new occlusion of bilateral superior pulmonary veins and diffuse pulmonary edema. Pulmonary vein occlusion is confirmed by trans-esophageal echocardiogram, and PVOD and hemangiomatosis is corroborated with lung biopsy. Normal pulmonary capillary wedge pressure (PCWP) and reduced DLCO are also consistent with PVOD. Vigilant evaluation of large pulmonary venous thrombus is as important as of arterial thrombus in a postsurgical transplant status. A dedicated protocol of pulmonary venous phase scan would be beneficial to identify subtle pulmonary venous abnormalities. Although PVOD/PCH is normally considered in patients with nonspecific PAH symptoms, lacking of direct manifestation of PAH should not dismiss the diagnosis of PVOD/PCH, particularly in lung transplant individuals with large pulmonary vein occlusion, progressive respiratory symptoms, DLCO abnormalities, and pulmonary congestion since it may represent a wide spectrum of occlusive vascular disease.
Collapse
Affiliation(s)
- Xiao Wang
- Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kexin Zheng
- Swenson College of Science and Engineering, University of Minnesota Duluth, Duluth, MN, USA
| | - Emilian Racila
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Tadashi Allen
- Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA
| |
Collapse
|
22
|
Tsuchiya N, Griffin L, Yamashiro T, Gibo S, Okane T, Yasutani T, Murayama S. Imaging findings of pulmonary edema: Part 2. Infrequent or unusual pulmonary edema with definitive imaging findings. Acta Radiol 2020; 61:195-203. [PMID: 31237773 DOI: 10.1177/0284185119856880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pulmonary edema is a common condition with numerous causes, some of which are infrequently encountered. This review article describes various uncommon conditions/disease that are associated with pulmonary edema and which show characteristic imaging findings on chest computed tomography or other imaging modality. Thus, this review reflects the variety of factors involved in this frequently encountered condition. We demonstrate the wide range of situations that lead to the development of pulmonary edema by showing the imaging findings of unique cases. These rare varieties of pulmonary edema have distinctive imaging and clinical features that aid in providing an accurate diagnosis.
Collapse
Affiliation(s)
- Nanae Tsuchiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lindsay Griffin
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Shinji Gibo
- Department of Radiology, Urasoe General Hospital, Okinawa, Japan
| | - Tsuyoshi Okane
- Department of Radiology, Urasoe General Hospital, Okinawa, Japan
| | | | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| |
Collapse
|
23
|
Anazawa R, Terada J, Sakao S, Shigeta A, Tanabe N, Tatsumi K. Features of radiological and physiological findings in pulmonary capillary hemangiomatosis: an updated pooled analysis of confirmed diagnostic cases. Pulm Circ 2019; 9:2045894019896696. [PMID: 31908771 DOI: 10.1177/2045894019896696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/30/2019] [Indexed: 11/16/2022] Open
Abstract
Pulmonary capillary hemangiomatosis (PCH) is a very rare and refractory disease characterized by capillary angioproliferation. The updated classification of pulmonary hypertension categorizes PCH into a subgroup of pulmonary arterial hypertension (PAH) alongside pulmonary veno-occlusive disease (PVOD). However, the definitive diagnosis of PCH only with noninvasive tools remains difficult. The aim of this study was to elucidate the radiological and physiological characteristics of PCH. We searched for cases of pathologically confirmed PCH in the English literature published between 2000 and 2018. We identified 26 cases among 39 studies. Then, we extracted and evaluated the relevant clinical information in all cases with available data. On chest computed tomography (CT), ground-glass opacities (GGOs) were observed in 92% of the cases, in which poorly defined nodular pattern was the most common (88%). GGOs in a bat-wing distribution were observed in one case. Septal lines and lymph node enlargement were observed less frequently (each 19%, 12%). Seven cases (27%) had overlapping abnormalities. Diffusing capacity of the lung for carbon monoxide (DLCO) was remarkably decreased. Alveolar hemorrhage by histological findings or bronchoalveolar lavage (BAL) was observed in seven cases. The present study showed that the most characteristic findings of CT in PCH was centrilobular GGOs with a poorly defined nodular pattern, and septal lines and lymph node enlargement were seen less frequently. Alveolar hemorrhage detected by BAL and decreased DLCO may also be helpful to recognize the possibility of PCH like PVOD.
Collapse
Affiliation(s)
- Rie Anazawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Jiro Terada
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Ayako Shigeta
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Nobuhiro Tanabe
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| |
Collapse
|
24
|
Kobayashi H, Otsuki Y, Yamaguchi M, Ko K, Mizuno S, Ujita M, Ohashi R, Sato T, Sato H, Suzuki T. An Autopsy Case of Pulmonary Capillary Hemangiomatosis with an Electron Microscopy Study. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1551-1557. [PMID: 31636247 PMCID: PMC6818641 DOI: 10.12659/ajcr.918375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/31/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pulmonary capillary hemangiomatosis (PCH) and pulmonary veno-occlusive disease (PVOD) are rare diseases that share clinical, X-ray, and histological features. Most patients have poor prognosis due to severe respiratory impairment. Recently, EIF2AK4 mutations were found in some patients with PCH and PVOD, but the role of this mutation is still unknown. We report an autopsy case of PCH and discuss a mechanism of respiratory dysfunction based on an electron microscopy study. CASE REPORT The patient was a Japanese man in his sixties. He suffered from acute exacerbation of dyspnea during treatment of COPD. Respiratory function testing revealed DLCO' 32.1% and DLCO'/VA 23.6%. Echocardiography demonstrated findings consistent with pulmonary hypertension. A CT scan showed mild emphysema and small ground-glass opacity in the lungs. However, we could not find the exact cause of his respiratory failure and he died 28 days after admission. At autopsy, the histology showed multilayering capillary proliferation within the alveolar walls. Electron microscopy examination revealed prominent widening of the air-blood barrier, scarce fusion of the epithelial and capillary basement membranes, and frequent narrowing of the capillary lumen. CONCLUSIONS We reported an autopsy case with PCH with no histological findings of PVOD. Whether PCH and PVOD are 2 different histological patterns of the same disease remains to be verified. The changes in the air-blood barrier detected by electron microscopy may explain the respiratory impairment and pulmonary arterial hypertension.
Collapse
Affiliation(s)
- Hiroshi Kobayashi
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Misako Yamaguchi
- Department of Pulmonology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Kento Ko
- Department of Pulmonology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Shogo Mizuno
- Clinical Laboratory, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Masuo Ujita
- Department of Radiology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Riuko Ohashi
- Department of Histopatholy, Core Facility, Niigata University, Faculty of Medicine, Niigata City, Niigata, Japan
| | - Takao Sato
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Hideo Sato
- Department of Respiratory Medicine, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Toshimitsu Suzuki
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| |
Collapse
|
25
|
Guzman S, Khan MS, Chodakiewitz Y, Khan M, Chodakiewitz MS, Julien P, Luthringer DJ. Pulmonary capillary hemangiomatosis: a lesson learned. AUTOPSY AND CASE REPORTS 2019; 9:e2019111. [PMID: 31528628 PMCID: PMC6709648 DOI: 10.4322/acr.2019.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/22/2019] [Indexed: 12/02/2022] Open
Abstract
Pulmonary capillary hemangiomatosis (PCH) is a rare and controversial entity that is known to be a cause of pulmonary hypertension and is microscopically characterized by proliferation of dilated capillary-sized channels along and in the alveolar walls. Clinically, it is mostly seen in adults. Clinical features are characterized by nonspecific findings such as shortness of breath, cough, chest pain, and fatigue. It can be clinically indistinguishable from pre-capillary pulmonary arterial hypertension disorders such as primary pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension. However, the diagnostic distinction, which usually requires a multidisciplinary approach, is crucial in order to avoid inappropriate treatment with vasodilator medications usually used for PAH treatment. Prognosis of PCH remains poor with lung transplant being the only definitive treatment. We report an autopsy case of pulmonary capillary hemangiomatosis unmasked at autopsy that was treated with a prostacyclin analog, usually contraindicated in such patients. We emphasize that this entity should always be on the differential diagnosis in a patient with pulmonary hypertension and requires great vigilance on the part of the clinician, radiologist and pathologist to make the diagnosis and guide appropriate management.
Collapse
Affiliation(s)
- Samuel Guzman
- Cedars Sinai Medical Center, Departments of Pathology & Radiology. Los Angeles, CA, United States of America
| | - Mohammad S Khan
- Cedars Sinai Medical Center, Departments of Pathology & Radiology. Los Angeles, CA, United States of America
| | - Yosef Chodakiewitz
- Cedars Sinai Medical Center, Departments of Pathology & Radiology. Los Angeles, CA, United States of America
| | - Maham Khan
- Foundation University Medical College. Islamabad, Pakistan
| | | | - Peter Julien
- Cedars Sinai Medical Center, Departments of Pathology & Radiology. Los Angeles, CA, United States of America
| | - Daniel J Luthringer
- Cedars Sinai Medical Center, Departments of Pathology & Radiology. Los Angeles, CA, United States of America
| |
Collapse
|
26
|
Yeo CD, Han D, Lee J, Chung WB, Jung JI, Lee KY, Kim TJ, Jang W, Kim M, Kang JY. A case of early diagnosis of pulmonary capillary hemangiomatosis in a worker with exposure to silica. BMC Pulm Med 2019; 19:133. [PMID: 31337372 PMCID: PMC6651969 DOI: 10.1186/s12890-019-0896-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary capillary hemangiomatosis (PCH) is a progressive and refractory vascular disease in the lung. Pulmonary hypertension is frequently combined with PCH when capillary proliferation invades to nearby pulmonary vascular systems. It is difficult to differentiate PCH from other diseases such as pulmonary venoocclusive disease and pulmonary arterial hypertension that cause pulmonary hypertension as they frequently overlap. Case presentation A 29-year-old female who had worked at a bathtub factory presented with progressive exertional dyspnea for the past 2 years. Computed tomography revealed centrilobular, diffusely spreading ground-glass opacities sparing subpleural parenchyma with some cystic lesions and air-trapping in both lungs, suggesting a peculiar pattern of interstitial lung disease with airway involvement. There was not any evidence of right heart failure or pulmonary hypertension on echocardiogram, as well as radiography. Microscopic examination of the lung by thoracoscopic resection showed atypical proliferation of capillary channels within alveolar walls and interlobar septa, without invasion of large vessels. Conclusion We experienced a pathologically diagnosed PCH in a young female complaining progressive dyspnea with prior exposure to occupational silica or organic solvent without elevated right ventricular systolic pressure (RVSP) who showed atypical pattern of radiologic findings.
Collapse
Affiliation(s)
- Chang Dong Yeo
- Division of Allergy and Pulmonology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Deokjae Han
- Division of Allergy and Pulmonology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jongmin Lee
- Division of Allergy and Pulmonology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Woo-Baek Chung
- Division of Allergy and Pulmonology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jung Im Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo-Young Lee
- Department of Clinical Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Jung Kim
- Department of Clinical Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woori Jang
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Genetic Laboratory Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Myungshin Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Genetic Laboratory Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Young Kang
- Division of Allergy and Pulmonology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| |
Collapse
|
27
|
Computed tomographic and clinical features of pulmonary veno-occlusive disease: raising the radiologist's awareness. Clin Radiol 2019; 74:655-662. [PMID: 31178067 DOI: 10.1016/j.crad.2019.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/26/2019] [Indexed: 11/22/2022]
Abstract
Pulmonary veno-occlusive disease (PVOD) is a rare subtype of pulmonary arterial hypertension (PAH) characterised by preferential remodelling of the pulmonary venules. Differentiation from other subtypes of PAH is essential as the management can differ significantly; for example, initiation of vasodilator therapy may cause fatal pulmonary oedema in a patient with PVOD misdiagnosed with idiopathic PAH. PVOD also carries a substantially worse prognosis. Lung biopsy is required for definitive diagnosis, but this is hazardous, and ideally, should be avoided in pulmonary hypertension. Computed tomography (CT) may suggest the diagnosis, directing the patient towards specialist review. Potential distinguishing CT features between PVOD and other subtypes of PAH include interlobular septal thickening, mediastinal lymphadenopathy, and centrilobular ground-glass opacities. No evidence-based medical therapy exists for PVOD at present and lung transplantation remains the definitive treatment for eligible patients. Therefore, early radiological identification of this challenging diagnosis facilitates timely referral for transplant.
Collapse
|
28
|
Hur DJ, Sugeng L. Non-invasive Multimodality Cardiovascular Imaging of the Right Heart and Pulmonary Circulation in Pulmonary Hypertension. Front Cardiovasc Med 2019; 6:24. [PMID: 30931315 PMCID: PMC6427926 DOI: 10.3389/fcvm.2019.00024] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/20/2019] [Indexed: 12/13/2022] Open
Abstract
Pulmonary hypertension (PH) is defined as resting mean pulmonary arterial pressure (mPAP) ≥25 millimeters of mercury (mmHg) via right heart (RH) catheterization (RHC), where increased afterload in the pulmonary arterial vasculature leads to alterations in RH structure and function. Mortality rates have remained high despite therapy, however non-invasive imaging holds the potential to expedite diagnosis and lead to earlier initiation of treatment, with the hope of improving prognosis. While historically the right ventricle (RV) had been considered a passive chamber with minimal role in the overall function of the heart, in recent years in the evaluation of PH and RH failure the anatomical and functional assessment of the RV has received increased attention regarding its performance and its relationship to other structures in the RH-pulmonary circulation. Today, the RV is the key determinant of patient survival. This review provides an overview and summary of non-invasive imaging methods to assess RV structure, function, flow, and tissue characterization in the setting of imaging's contribution to the diagnostic, severity stratification, prognostic risk, response of treatment management, and disease surveillance implications of PH's impact on RH dysfunction and clinical RH failure.
Collapse
Affiliation(s)
- David J Hur
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States.,Division of Cardiology, Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States.,Echocardiography Laboratory, Yale New Haven Hospital, New Haven, CT, United States
| |
Collapse
|
29
|
Manjubashini D, Nagarajan K, Rajesh Kumar B. Pulmonary capillary hemangiomatosis: An unusual cause of primary pulmonary hypertension in a child with characteristic computed tomography imaging features. Lung India 2019; 36:157-159. [PMID: 30829252 PMCID: PMC6410579 DOI: 10.4103/lungindia.lungindia_122_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pulmonary capillary hemangiomatosis (PCH) is a rare cause of primary pulmonary hypertension (PPH) diagnosed in children and young adults with a nonspecific clinical presentation of dyspnea, cough, chest pain, and fatigue. It is characterized by extensive proliferation of pulmonary capillaries within alveolar septa. The imaging features include diffuse centrilobular ground-glass opacities with features of pulmonary hypertension. We present a case of PCH in an 11-year-old boy who was diagnosed with PPH in echocardiography and referred for diagnostic imaging.
Collapse
Affiliation(s)
- D Manjubashini
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - K Nagarajan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - B Rajesh Kumar
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| |
Collapse
|
30
|
den Toom ML, Grinwis G, van Suylen RJ, Boroffka SA, de Jong P, van Steenbeek FG, Szatmári V. Pulmonary veno-occlusive disease as a cause of severe pulmonary hypertension in a dog. Acta Vet Scand 2018; 60:78. [PMID: 30518401 PMCID: PMC6282261 DOI: 10.1186/s13028-018-0433-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/30/2018] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary veno-occlusive disease (PVOD) is a rare cause of pulmonary arterial hypertension (PAH) in humans and can be classified in idiopathic, heritable, drug and radiation-induced, and associated with connective tissue disease or human immunodeficiency virus infection. Recently, biallelic mutations of the EIF2AK4 gene have been discovered as a cause for an autosomal recessive form of PVOD in humans. In dogs, PAH is poorly characterized and is generally considered to be idiopathic or secondary to (for example) congenital left-to right cardiovascular shunts or heartworm disease. However, recently, the pathologic features resembling human PVOD were retrospectively described in post-mortem lung samples of dogs presenting with respiratory distress and idiopathic pulmonary hypertension (PH), which suggests that PVOD contributes to an unknown percentage of cases with unexplained PH. In dogs, information on the clinical presentation of PVOD is scarce and the cause and pathogenesis of this disease is still unknown. Case presentation An 11-year-old, intact male German Shepherd dog (GSD) was presented with a 2-day history of acute-onset dyspnea and generalized weakness. Physical examination, laboratory analysis, thoracic radiography, echocardiography, a computed tomography scan and an ante mortem lung biopsy demonstrated severe arterial hypoxemia and severe PH but were not diagnostic for a known disease syndrome. Based on the poor reaction to therapy with oxygen, sildenafil, pimobendan and dexamethasone the dog was euthanized. Histopathology of the lungs showed venous and arterial remodelling, segmental congestion of alveolar capillaries and foci of vascular changes similar to human pulmonary capillary hemangiomatosis, indicating that the dog suffered from PVOD. Whole genome sequencing analysis was performed on the case and a healthy GSD. Validation was performed by Sanger sequencing of five additional GSD's unknown for any form of respiratory stress and aged ≥ 10 years. No causal variants were found in the genes that are known to be involved in human PVOD and PAH. Conclusions This case report confirms that PVOD should be a diagnostic consideration in dogs presenting with dyspnea and unexplained PH. In the present case, no casual genetic mutations known to be involved in humans with PVOD and PAH were found.
Collapse
|
31
|
Reinero CR, Jutkowitz LA, Nelson N, Masseau I, Jennings S, Williams K. Clinical features of canine pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis. J Vet Intern Med 2018; 33:114-123. [PMID: 30499214 PMCID: PMC6335444 DOI: 10.1111/jvim.15351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/28/2018] [Indexed: 01/29/2023] Open
Abstract
Background Histologic features of pulmonary veno‐occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH) have been described in dogs but without a thorough clinical description. Objectives To report the clinical features, diagnostics, treatment, and outcome of dogs with histologic evidence of PVOD and PCH. Animals Fifteen pet dogs meeting histopathologic criteria of PVOD (occlusive remodeling of small‐sized to medium‐sized pulmonary veins) or PCH (alveolar capillary proliferation and congestion), or both. Methods Medical records of dogs with PVOD and PCH identified based on histopathologic features between 2003 and 2017 were retrospectively reviewed. Results Fifteen dogs met inclusion criteria of a histologic diagnosis of PVOD or PCH or both. Dogs were older (median 11 years) with no apparent breed or sex predisposition. Dogs presented with acute clinical signs (median 3 days), usually respiratory distress. Thoracic radiography (available in 10 dogs) revealed right cardiomegaly and patchy or diffuse interstitial to alveolar patterns, with 9 dogs having a normal left cardiac silhouette. In 5 dogs tested, pulmonary arterial hypertension (PAH) was documented. In all 3 dogs, thoracic computed tomography scans showed pulmonary arterial enlargement and perivascular diffuse nodular ground‐glass opacities. Ten of 15 dogs died within 1 day; median survival was 3 days. Conclusions and Clinical Importance In dogs with PAH, the inability to document left‐sided congestive heart failure and failure to identify another cause of signs of respiratory disease should increase suspicion for PVOD and PCH. With increased awareness of PVOD and PCH by clinicians and pathologists, dogs with compatible clinicopathologic features should be evaluated for these pulmonary vascular disorders.
Collapse
Affiliation(s)
- Carol R Reinero
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri
| | - L Ari Jutkowitz
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| | - Nathan Nelson
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina
| | - Isabelle Masseau
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri.,Department of Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, Canada
| | - Samuel Jennings
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Kurt Williams
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| |
Collapse
|
32
|
Sharma A, Pandey NN, Kumar S. Pulmonary capillary haemangiomatosis causing pulmonary arterial hypertension: a clinician's conundrum. BMJ Case Rep 2018; 2018:bcr-2018-227393. [PMID: 30297486 DOI: 10.1136/bcr-2018-227393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Arun Sharma
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
33
|
Zhao J, Shao J, Zhu L, Yu K, Zhao R, Ding W, Zhang J, Han Y. Solitary pulmonary capillary hemangioma: Clinicopathologic and radiologic characteristics of nine surgically resected cases. Pathol Res Pract 2018; 214:1885-1891. [PMID: 30268596 DOI: 10.1016/j.prp.2018.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/28/2018] [Accepted: 09/14/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Solitary pulmonary capillary hemangioma (SPCH) is an extraordinarily rare capillary derived mesenchymal neoplasm. Although routine morphology and immunohistochemistry are adequate for the diagnosis of classical SPCH in surgical specimens, true gross appearance identification of most tumor themselves and diagnosis for some exceptional cases are still very difficult. Furthermore, preoperative imaging and frozen diagnosis remain a challenge. METHODS We reported nine original cases of solitary pulmonary capillary hemangioma and summarized the clinical characteristics of twenty-one reported lesions. Imaging materials were reviewed by the image experts of our hospital. Quick hematoxylin-eosin stained intraoperative frozen sections and routine histological diagnosis were re-confirmed by 3 specialist pathologists with at least 10 years of diagnostic experience in our department. Immunohistochemistry analysis was performed on formalin fixed archival tissue. The surgical methods, following up information and prognosis were retrospectively analyzed. RESULTS In imaging, three tumors showed solid nodules, three cases displayed mix ground glass nodules, two nodules were pure ground glass density, and one case was a cystic-solid mass. Macroscopically, solitary pulmonary capillary hemangiomas were ill-defined soft hemorrhagic lesion with pale yellow or dark brownish cut surface. Two cases had a clear boundary and seven lesions were poorly demarcated. Typical morphological features were densely proliferating thin-walled capillaries composing of single layer of flatten or cuboidal endothelial cells within the thickened alveolar septa. One case was mistaken for a histiocytogenic lesion during freezing. The cystic-solid lesion showed a hyperplasia capillary network along the submucosal interstitium of bronchioles. Immunohistochemically, tumor endothelial cells were positive for ERG, Fli-1, CD31, CD34 and Vimentin and negative for CK, α-SMA, TTF-1, HMB45, S-100 and CD68. Lobectomy was performed on seven cases, wedge resection and segmentectomy were proceeded in two patients respectively. Follow up information showed no evidence of complication or recurrence. CONCLUSIONS Solitary pulmonary capillary hemangioma has special imaging and various histological features and must be distinguished from small benign lung lesions and preinvasive cancer. Although the prognosis of this tumor is good after surgical resection, the correct interpretation of the gross appearance and radiographic findings are still important. Choosing appropriate resection mode depends on accurate evaluation preoperative and intraoperative.
Collapse
Affiliation(s)
- Jikai Zhao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jinchen Shao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Lei Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Keke Yu
- Department of Biobank, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Ruiying Zhao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wenjie Ding
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jie Zhang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yuchen Han
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
| |
Collapse
|
34
|
Clinical prediction score for identifying patients with pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis. J Cardiol 2018; 72:255-260. [DOI: 10.1016/j.jjcc.2018.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/20/2018] [Accepted: 02/06/2018] [Indexed: 01/25/2023]
|
35
|
Suffredini DA, Lee JM, Peer CJ, Pratt D, Kleiner DE, Elinoff JM, Solomon MA. Pulmonary tumor thrombotic microangiopathy and pulmonary veno-occlusive disease in a woman with cervical cancer treated with cediranib and durvalumab. BMC Pulm Med 2018; 18:112. [PMID: 29996818 PMCID: PMC6042377 DOI: 10.1186/s12890-018-0681-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 06/27/2018] [Indexed: 11/16/2022] Open
Abstract
Background Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare cause of pulmonary hypertension that is associated with malignancies and is marked by the presence of non-occlusive tumor emboli and fibrocellular intimal proliferation of small pulmonary arteries leading to increased pulmonary vascular resistance and right heart failure. The diagnosis of PTTM is challenging to make pre-mortem and guidelines on treatment are lacking. Case presentation A 45-year-old woman with advanced squamous cell carcinoma of the cervix developed symptoms of dyspnea and evidence of right heart failure during a phase I clinical trial with cediranib and durvalumab. After an extensive evaluation, pre-capillary pulmonary hypertension was confirmed by right heart catheterization. Vasodilator therapy was initiated but resulted in the development of symptomatic hypoxemia and was discontinued. Despite continued supportive care, she continued to decline and was transitioned to hospice care. At autopsy, the cause of her right heart failure was found to be due to PTTM with features of pulmonary veno-occlusive disease (PVOD). Conclusion PTTM and PVOD are important diagnoses to consider in patients with a malignancy and the development of right heart failure and may be manifestations of a spectrum of similar disease processes.
Collapse
Affiliation(s)
- Dante A Suffredini
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA.
| | - Jung-Min Lee
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Cody J Peer
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Drew Pratt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - David E Kleiner
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Jason M Elinoff
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Michael A Solomon
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA.,Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, USA
| |
Collapse
|
36
|
Dellegrottaglie S, Ostenfeld E, Sanz J, Scatteia A, Perrone-Filardi P, Bossone E. Imaging the Right Heart-Pulmonary Circulation Unit. Heart Fail Clin 2018; 14:377-391. [DOI: 10.1016/j.hfc.2018.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
37
|
Pulmonary capillary hemangiomatosis diagnosed by pathology of explanted lungs: a unique etiology serves as a key of clinical diagnosis. Gen Thorac Cardiovasc Surg 2018; 67:332-335. [DOI: 10.1007/s11748-018-0950-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/21/2018] [Indexed: 11/25/2022]
|
38
|
Batra K, Dessouky R, Butt YM, Wadhwa V, Torrealba JR, Glazer C. Series of rare lung diseases mimicking imaging patterns of common diffuse parenchymal lung diseases. Lung India 2018; 35:231-236. [PMID: 29697080 PMCID: PMC5946556 DOI: 10.4103/lungindia.lungindia_291_17] [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] [Indexed: 11/24/2022] Open
Abstract
Diffuse parenchymal lung diseases (DPLDs) encompass a variety of restrictive and obstructive lung pathologies. In this article, the authors discuss a series of rare pulmonary entities and their high-resolution computed tomography imaging appearances, which can mimic more commonly encountered patterns of DPLDs. These cases highlight the importance of surgical lung biopsies in patients with imaging findings that do not show typical imaging features of usual interstitial pneumonia.
Collapse
Affiliation(s)
- Kiran Batra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Riham Dessouky
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Yasmeen M Butt
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jose R Torrealba
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Craig Glazer
- Department of Pulmonology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
39
|
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary Veins. Radiographics 2018; 37:1928-1954. [PMID: 29131765 DOI: 10.1148/rg.2017170050] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The pulmonary veins carry oxygenated blood from the lungs to the heart, but their importance to the radiologist extends far beyond this seemingly straightforward function. The anatomy of the pulmonary veins is variable among patients, with several noteworthy variant and anomalous patterns, including supernumerary pulmonary veins, a common ostium, anomalous pulmonary venous return, and levoatriocardinal veins. Differences in pulmonary vein anatomy and the presence of variant or anomalous anatomy can be of critical importance, especially for preoperative planning of pulmonary and cardiac surgery. The enhancement or lack of enhancement of the pulmonary veins can be a clue to clinically important disease, and the relationship of masses to the pulmonary veins can herald cardiac invasion. The pulmonary veins are also an integral part of thoracic interventions, including lung transplantation, pneumonectomy, and radiofrequency ablation for atrial fibrillation. This fact creates a requirement for radiologists to have knowledge of the pre- and postoperative imaging appearances of the pulmonary veins. Many of these procedures are associated with important potential complications involving the pulmonary veins, for which diagnostic imaging plays a critical role. A thorough knowledge of the pulmonary veins and a proper radiologic approach to their evaluation is critical for the busy radiologist who must incorporate the pulmonary veins into a routine "search pattern" at computed tomography (CT) and magnetic resonance imaging. This article is a comprehensive CT-based imaging review of the pulmonary veins, including their embryology, anatomy (typical and anomalous), surgical implications, pulmonary vein thrombosis, pulmonary vein stenosis, pulmonary vein pseudostenosis, and the relationship of tumors to the pulmonary veins. Online supplemental material is available for this article. ©RSNA, 2017.
Collapse
Affiliation(s)
- Cameron Hassani
- From the Department of Radiology, Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
| | - Farhood Saremi
- From the Department of Radiology, Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
| |
Collapse
|
40
|
Sirajuddin A, Donnelly EF, Crabtree TP, Henry TS, Iannettoni MD, Johnson GB, Kazerooni EA, Maldonado F, Olsen KM, Wu CC, Mohammed TL, Kanne JP. ACR Appropriateness Criteria ® Suspected Pulmonary Hypertension. J Am Coll Radiol 2018; 14:S350-S361. [PMID: 28473092 DOI: 10.1016/j.jacr.2017.01.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 11/15/2022]
Abstract
Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations that may be helpful in diagnosing and determining the etiology of pulmonary hypertension are discussed. Imaging examinations that may aid in the diagnosis of pulmonary hypertension include chest radiography, ultrasound echocardiography, ventilation/perfusion scans, CT, MRI, right heart catheterization, pulmonary angiography, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | | | - Edwin F Donnelly
- Panel Vice-Chair, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Traves P Crabtree
- Southern Illinois University School of Medicine, Springfield, Illinois; Society of Thoracic Surgeons
| | - Travis S Henry
- University of California, San Francisco, San Francisco, California
| | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Carol C Wu
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tan-Lucien Mohammed
- Specialty Chair, University of Florida College of Medicine, Gainesville, Florida
| | - Jeffrey P Kanne
- Panel Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
41
|
Aluja Jaramillo F, Gutierrez FR, Díaz Telli FG, Yevenes Aravena S, Javidan-Nejad C, Bhalla S. Approach to Pulmonary Hypertension: From CT to Clinical Diagnosis. Radiographics 2018; 38:357-373. [PMID: 29432063 DOI: 10.1148/rg.2018170046] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pulmonary hypertension (PH) is a condition characterized by increased pressure in the pulmonary circulation. It may be idiopathic or arise in the setting of other clinical conditions. Patients with PH tend to present with nonspecific cardiovascular or respiratory symptoms. The clinical classification of PH was recently revised at the World Health Organization symposium in Nice, France, in 2013. That consensus statement provided an updated classification based on the shared hemodynamic characteristics and management of the different categories of PH. Some features seen at computed tomography (CT) can suggest a subtype or probable cause of PH that may facilitate placing the patient in the correct category. These features include findings in the pulmonary arteries (peripheral calcification, peripheral dilatation, eccentric filling defects, intra-arterial soft tissue), lung parenchyma (centrilobular nodules, mosaic attenuation, interlobular septal thickening, bronchiectasis, subpleural peripheral opacities, ground-glass opacities, diffuse nodules), heart (congenital lesions, left heart disease, valvular disease), and mediastinum (hypertrophied bronchial arteries). An approach based on identification of these CT features in patients with PH will allow the radiologist to play an important role in diagnosis and help guide the clinician in management of PH. ©RSNA, 2018.
Collapse
Affiliation(s)
- Felipe Aluja Jaramillo
- From the Department of Radiology, Country Scan, Carrera 16 # 84a - 09 Cons. 323, Bogotá, Colombia (F.A.J.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.R.G., C.J.N., S.B.); Department of Radiology, Hospital Austral de Buenos Aires, Pilar Centro, Buenos Aires, Argentina (F.G.D.T.); and Department of Radiology, Clínica Las Condes, Las Condes, Región Metropolitana, Chile (S.Y.A.)
| | - Fernando R Gutierrez
- From the Department of Radiology, Country Scan, Carrera 16 # 84a - 09 Cons. 323, Bogotá, Colombia (F.A.J.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.R.G., C.J.N., S.B.); Department of Radiology, Hospital Austral de Buenos Aires, Pilar Centro, Buenos Aires, Argentina (F.G.D.T.); and Department of Radiology, Clínica Las Condes, Las Condes, Región Metropolitana, Chile (S.Y.A.)
| | - Federico G Díaz Telli
- From the Department of Radiology, Country Scan, Carrera 16 # 84a - 09 Cons. 323, Bogotá, Colombia (F.A.J.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.R.G., C.J.N., S.B.); Department of Radiology, Hospital Austral de Buenos Aires, Pilar Centro, Buenos Aires, Argentina (F.G.D.T.); and Department of Radiology, Clínica Las Condes, Las Condes, Región Metropolitana, Chile (S.Y.A.)
| | - Sebastian Yevenes Aravena
- From the Department of Radiology, Country Scan, Carrera 16 # 84a - 09 Cons. 323, Bogotá, Colombia (F.A.J.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.R.G., C.J.N., S.B.); Department of Radiology, Hospital Austral de Buenos Aires, Pilar Centro, Buenos Aires, Argentina (F.G.D.T.); and Department of Radiology, Clínica Las Condes, Las Condes, Región Metropolitana, Chile (S.Y.A.)
| | - Cylen Javidan-Nejad
- From the Department of Radiology, Country Scan, Carrera 16 # 84a - 09 Cons. 323, Bogotá, Colombia (F.A.J.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.R.G., C.J.N., S.B.); Department of Radiology, Hospital Austral de Buenos Aires, Pilar Centro, Buenos Aires, Argentina (F.G.D.T.); and Department of Radiology, Clínica Las Condes, Las Condes, Región Metropolitana, Chile (S.Y.A.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Country Scan, Carrera 16 # 84a - 09 Cons. 323, Bogotá, Colombia (F.A.J.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.R.G., C.J.N., S.B.); Department of Radiology, Hospital Austral de Buenos Aires, Pilar Centro, Buenos Aires, Argentina (F.G.D.T.); and Department of Radiology, Clínica Las Condes, Las Condes, Región Metropolitana, Chile (S.Y.A.)
| |
Collapse
|
42
|
Pulmonary Complications of Malignancies and Blood and Marrow Transplantation. PULMONARY COMPLICATIONS OF NON-PULMONARY PEDIATRIC DISORDERS 2018. [PMCID: PMC7120544 DOI: 10.1007/978-3-319-69620-1_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
43
|
J. Vazquez F, Paulin P, Rodriguez P, Lubertino M, Gándara E. The outcome of pulmonary vein thrombosis in non-surgical patients. A systematic review and case report. Thromb Haemost 2017; 113:1151-4. [DOI: 10.1160/th14-11-0933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 12/31/2014] [Indexed: 11/05/2022]
|
44
|
Balko R, Edriss H, Nugent K, Test V. Pulmonary veno-occlusive disease: An important consideration in patients with pulmonary hypertension. Respir Med 2017; 132:203-209. [PMID: 29229098 DOI: 10.1016/j.rmed.2017.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 09/11/2017] [Accepted: 10/20/2017] [Indexed: 11/16/2022]
Abstract
Pulmonary veno-occlusive disease is a rare subcategory of pulmonary arterial hypertension (WHO Group 1). The disease is poorly understood and difficult to diagnose; it has no definitive cure to date. These patients present with nonspecific symptoms, including dyspnea, exercise intolerance, and weakness. Chest x-rays sometimes differ from idiopathic pulmonary arterial hypertension and may demonstrate alveolar infiltrates and pleural effusions. High resolution computed tomography scans reveal ground glass opacities, interlobular septal thickening, and lymphadenopathy. Echocardiography can estimate the level of pulmonary artery pressures; right heart catheterization is needed for complete hemodynamic characterization of these patients. Lung biopsies demonstrate remodeling of the venules and small veins with intimal and adventitial fibrosis. This can result in total venous occlusion and subsequent recanalization. Similar changes occur in the small arteries and arterioles but are less pronounced than the venous changes. There is no effective medical therapy for these patients, and treatment with the pulmonary arterial hypertension specific medications often causes acute deterioration with pulmonary edema. The recent discovery of the biallelic mutations of the EIF2AK4 gene as an etiology for heritable form of pulmonary veno-occlusive disease increases our understanding of the disease pathogenesis and potentially identifies a future approach to treatment. Without definitive treatment, the prognosis is very poor, and the life expectancy of these patients is much shorter than patients with pulmonary arterial hypertension. These patients need early referral to transplantation centers.
Collapse
Affiliation(s)
- Ryan Balko
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Hawa Edriss
- Division of Pulmonary and Critical Care, Texas Tech University Health Science Center, Lubbock, TX, USA.
| | - Kenneth Nugent
- Division of Pulmonary and Critical Care, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Victor Test
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
45
|
Zhu Y, Qu N, Sun L, Meng X, Li X, Zhang Y. Solitary pulmonary capillary hemangioma presents as ground glass opacity on computed tomography indicating adenocarcinoma in situ/atypical adenomatous hyperplasia: A case report. Biomed Rep 2017; 7:515-519. [PMID: 29188054 PMCID: PMC5702956 DOI: 10.3892/br.2017.997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/14/2017] [Indexed: 11/18/2022] Open
Abstract
Solitary pulmonary capillary hemangioma (SPCH) is a rare type of benign lung tumor, which must be distinguished from early lung cancer and precancerous lesions of the lung that manifest in a similar way upon imaging. The current study describes a case of SPCH and a review of the literature is performed. The patient was a 40-year-old Chinese woman who was referred to the Liaoning Cancer Hospital and Institute (Shenyang, China) in October, 2015 with a cough without obvious inducement. Computed tomography (CT) demonstrated pure ground glass opacity (GGO) in the right upper lung. Following systemic anti-inflammatory therapy over 6 months, the lesion did not exhibit any change on CT and was suspected to be an adenocarcinoma in situ (AIS) or atypical adenomatous hyperplasia (AAH). Video-assisted thoracic surgery wedge resection was subsequently performed. Frozen section diagnosis revealed a benign tumor without atypical epithelial cells. Subsequent to surgery, paraffin sections demonstrated that the tumor contained narrow alveolar cavities, thickened alveolar septa and a clear boundary separating it from healthy lung tissue. Furthermore, the proliferation lumens in the alveolar septa were lined with a single layer of flat cells. Immunohistochemical staining revealed that the flat cells were positive for cluster of differentiation CD31 and CD34, and negative for thyroid transcription factor-1 and cytokeratin. The proliferation of capillary vessels lead to the thickened alveolar septa and the tumor was diagnosed as SPCH. When imaging examination demonstrates a GGO in lung, SPCH must be considered in the differential diagnosis of AIS/AAH. As the prognosis of these lesions is entirely different, a pathological examination must be conducted to ensure a correct diagnosis.
Collapse
Affiliation(s)
- Yanmei Zhu
- Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| | - Ning Qu
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| | - Lili Sun
- Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| | - Xiao Meng
- Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| | - Xiaoyan Li
- Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| | - Yong Zhang
- Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| |
Collapse
|
46
|
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the potentially curable causes of pulmonary hypertension and is definitively treated with pulmonary thromboendartectomy. CTEPH can be overlooked, as its symptoms are nonspecific and can be mimicked by a wide range of diseases that can cause pulmonary hypertension. Early diagnosis of CTEPH and prompt evaluation for surgical candidacy are paramount factors in determining future outcomes. Imaging plays a central role in the diagnosis of CTEPH and patient selection for pulmonary thromboendartectomy and balloon pulmonary angioplasty. Currently, various imaging tools are used in concert, with techniques such as computed tomography (CT) and conventional pulmonary angiography providing detailed structural information, tests such as ventilation-perfusion (V/Q) scanning providing functional data, and magnetic resonance imaging providing a combination of morphologic and functional information. Emerging techniques such as dual-energy CT and single photon emission computed tomography-CT V/Q scanning promise to provide both anatomic and functional information in a single test and may change the way we image these patients in the near future. In this review, we discuss the roles of various imaging techniques and discuss their merits, limitations, and relative strengths in depicting the structural and functional changes of CTEPH. We also explore newer imaging techniques and the potential value they may offer.
Collapse
|
47
|
Jaffey JA, Williams KJ, Masseau I, Krueger M, Reinero C. Vasoproliferative process resembling pulmonary capillary hemangiomatosis in a cat. BMC Vet Res 2017; 13:72. [PMID: 28320395 PMCID: PMC5359803 DOI: 10.1186/s12917-017-0984-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary capillary hemangiomatosis is a rare, vascular obstructive disorder that uniformly causes pulmonary arterial hypertension. Clinically, pulmonary capillary hemangiomatosis is indistinguishable from primary pulmonary arterial hypertension and histology is required for definitive diagnosis. The distinctive histologic feature of pulmonary capillary hemangiomatosis is non-malignant extensive proliferation of capillaries in the alveolar septae. Vasodilator treatment of humans with primary arterial hypertension due to pulmonary capillary hemangiomatosis can result in fatal acute pulmonary edema. Computed tomography is thus critical to discern pulmonary capillary hemangiomatosis from other causes of pulmonary arterial hypertension prior to vasodilator therapy. This is the first report of a vasoproliferative process resembling pulmonary capillary hemangiomatosis in the feline species. CASE PRESENTATION A 15-year-old, male castrated, domestic shorthair cat presented for persistent labored breathing presumptively due to congestive heart failure despite treatment with diuretics for 7 days. Echocardiography showed evidence of hypertrophic cardiomyopathy with severe pulmonary hypertension; however, a normal sized left atrium was not consistent with congestive heart failure. Thoracic computed tomography was performed and showed evidence of diffuse ill-defined nodular ground glass opacities, enlarged pulmonary arteries, and filling defects consistent with pulmonary thromboembolism. The cat acutely decompensated after a single dose of sildenafil and was euthanized. Histopathology of the lungs showed severe multifocal alveolar capillary proliferation with respiratory bronchiolar infiltration, marked type II pneumocyte hyperplasia and multifocal pulmonary arterial thrombosis. CONCLUSION This is the first description in a cat of a vasoproliferative disorder resembling pulmonary capillary hemangiomatosis complicated by multifocal pulmonary arterial thrombosis. Inspiratory and expiratory ventilator-driven breath holds with angiography revealed lesions predominantly characterized by ground glass opacification and vascular filling defects with absence of air trapping. The results from this report suggest that, as in humans, the cat can develop a pulmonary capillary hemangiomatosis-like disease in which vasodilator therapy to address pulmonary hypertension may lead to fatal pulmonary edema.
Collapse
Affiliation(s)
- J A Jaffey
- University of Missouri Veterinary Health Center, Columbia, MO, USA
| | - K J Williams
- Michigan State University, East Lansing, MI, USA
| | - I Masseau
- Université de Montréal, St-Hyacinthe, Québec, Canada
| | - M Krueger
- Veterinary Specialty Hopsital of Hong Kong, Wan Chai, Hong Kong
| | - C Reinero
- University of Missouri Veterinary Health Center, Columbia, MO, USA.
| |
Collapse
|
48
|
Pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis. Med Clin (Barc) 2017; 148:265-270. [PMID: 28118962 DOI: 10.1016/j.medcli.2016.11.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022]
Abstract
Pulmonary veno-occlusive disease is a rare cause of pulmonary hypertension which is part, together with pulmonary capillary hemangiomatosis, of the special designation (subgroup 1') within pulmonary hypertension group 1 in the latest classification of the pulmonary hypertension World Symposium. Recent discovery that gene mutations in eukaryotic translation initiation factor 2 alpha kinase 4 (EIF2AK4) are responsible for inherited forms of pulmonary veno-occlusive disease has changed the role of genetic testing, acquiring relevant importance in the diagnosis of these patients. Despite the advances in genetic, cellular and molecular basis knowledge in the last decade, pulmonary veno-occlusive disease remains as a rare aetiology of pulmonary hypertension without any effective medical treatment approved and poor outcomes. This document aims to review the advances occurred in the understanding of pulmonary veno-occlusive disease in the last years.
Collapse
|
49
|
|
50
|
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]
|