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Emad Y, Ragab Y, Farber HW, Erkan D, Ibrahim O, Kindermann M, Tekavec-Trkanjec J, Jayakrishnan B, El-Shaarawy N, Kechida M, Young P, Pankl S, Fabi M, Bawaskar P, Kably I, Ghirardo S, Frikha F, Abou-Zeid A, Hassan M, Robinson C, Abdelbary MH, Tornes L, Margolesky J, Barman B, Bennji S, Agarwala MK, Alhusseiny K, Amezyane T, Silva RS, Cruz V, Niemeyer B, Al-Zeedy K, Al-Jahdali H, Jaramillo N, Demirkan S, Guffroy A, Kim JT, Ruffer N, Tharwat S, Cozzi D, Abdelali M, Joy TC, Sayed M, Sherwina J, Gheita T, Rasker JJ. Pulmonary embolism versus pulmonary vasculitis in Hughes-Stovin syndrome: Characteristic computed tomography pulmonary angiographic findings and diagnostic and therapeutic implications. HSS International Study Group. Thromb Res 2024; 239:109040. [PMID: 38795561 DOI: 10.1016/j.thromres.2024.109040] [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: 03/24/2024] [Revised: 05/11/2024] [Accepted: 05/21/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND AND AIM Hughes-Stovin syndrome (HSS) is a rare systemic vasculitis with widespread venous/arterial thrombosis and pulmonary vasculitis. Distinguishing between pulmonary embolism (PE) and in-situ thrombosis in the early stages of HSS is challenging. The aim of the study is to compare clinical, laboratory, and computed tomography pulmonary angiography (CTPA) characteristics in patients diagnosed with PE versus those with HSS. METHODS This retrospective study included 40 HSS patients with complete CTPA studies available, previously published by the HSS study group, and 50 patients diagnosed with PE from a single center. Demographics, clinical and laboratory findings, vascular thrombotic events, were compared between both groups. The CTPA findings were reviewed, with emphasis on the distribution, adherence to the mural wall, pulmonary infarction, ground glass opacification, and intra-alveolar hemorrhage. Pulmonary artery aneurysms (PAAs) in HSS were assessed and classified. RESULTS The mean age of HSS patients was 35 ± 12.3 years, in PE 58.4 ± 17 (p < 0.0001). Among PE 39(78 %) had co-morbidities, among HSS none. In contrast to PE, in HSS both major venous and arterial thrombotic events are seen.. Various patterns of PAAs were observed in the HSS group, which were entirely absent in PE. Parenchymal hemorrhage was also more frequent in HSS compared to PE (P < 0.001). CONCLUSION Major vascular thrombosis with arterial aneurysms formation are characteristic of HSS. PE typically appear loosely-adherent and mobile whereas "in-situ thrombosis" seen in HSS is tightly-adherent to the mural wall. Mural wall enhancement and PAAs are distinctive pulmonary findings in HSS. The latter findings have significant therapeutic ramifications.
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Harrison W Farber
- Tufts University School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Boston, MA, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Lancashire, Ashton Rd, Lancaster LA1 4RP, United Kingdom
| | - Michael Kindermann
- Innere Medizin III (Kardiologie/Angiologie), Universitätskliniken des Saarlandes, Kirrberger Straße, D 66421 Homburg/Saar, Germany
| | - Jasna Tekavec-Trkanjec
- Department of Pulmonary medicine, Dubrava University Hospital, AvenijaGojkaŠuška 6, 10000 Zagreb, Croatia
| | | | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia 4.5 Km the Ring Road, 41522 Ismailia, Egypt
| | - Melek Kechida
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, University of Monastir, Rue du 1er juin 1955, Monastir 5019, Tunisia
| | - Pablo Young
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Sonia Pankl
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Marianna Fabi
- Pediatric Cardiology and Adult Congenital Unit, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
| | - Parag Bawaskar
- Department of Cardiology, Topiwala National Medical College & B.Y.L Nair Charitable Hospital, Dr. A.L. Nair road, Mumbai 400008, Maharashtra, India
| | - Issam Kably
- Department of Radiology, Section of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sergio Ghirardo
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Piazzale Europa, 1, 34127 Trieste, TS, Italy
| | - Faten Frikha
- Department of Internal Medicine, HediChaker Hospital, 3029 Sfax, Tunisia
| | - Alaa Abou-Zeid
- Public health Department, Faculty of medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University - Al kartoom square, al Azareta, Alexandria 21526, Egypt
| | - Cal Robinson
- Department of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mohamed H Abdelbary
- Department of Radiology, Badr Hospital, Faculty of medicine, Helwan University, Egypt
| | - Leticia Tornes
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Jason Margolesky
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, India
| | - Sami Bennji
- Division of Pulmonology, Department of Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Manoj Kumar Agarwala
- Department of Cardiology, Apollo Hospitals, Jubilee Hills, Hyderabad 500096, India
| | - Khalid Alhusseiny
- Radiology department, Dr Erfan General hospital, Jeddah, Saudi Arabia
| | - Taoufik Amezyane
- Department of Internal Medicine, Mohammed V Military Teaching Hospital, Mohammed V-Souissi University, School of Medicine, Rabat, Morocco
| | - Rafael S Silva
- Unidad de Enfermedades Respiratorias, Hospital Regional de Talca, Calle 1 Norte 1990, Talca, Chile
| | - Vitor Cruz
- Serviço de Reumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Bruno Niemeyer
- Departamento de Radiologia, Instituto Estadual do Cérebro Paulo Niemeyer, R. do Rezende, 156 - Centro, 20231-092 Rio de Janeiro, RJ, Brazil
| | - Khalfan Al-Zeedy
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Hamdan Al-Jahdali
- Pulmonary Division, Department of Medicine, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Natalia Jaramillo
- Cardiology Department, Hospital Puerta de HierroMajadahonda, C/Joaquin Rodrigo 3, Madrid 28222, Spain
| | - Serkan Demirkan
- Department of Dermatology and Venerology, Izmir KatipÇelebi University Faculty of Medicine, Karabağlar, Izmir, Turkey
| | - Aurelien Guffroy
- Service d'immunologieclinique et médecine interne, centre de référence des maladies auto-immunes systémiquesrares (RESO), hôpitauxuniversitaires de Strasbourg, nouvelhôpital civil, 67091 Strasbourg, France; UFR médecine Strasbourg, université de Strasbourg, 67000 Strasbourg, France
| | - Jung Tae Kim
- Department of Cardiovascular and Thoracic Surgery, Cheonan Chungmu Hospital, 8 Dagamal 3-gil Seobuk-gu, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Nikolas Ruffer
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Samar Tharwat
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Mabrouk Abdelali
- Department of Radiology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Tubig C Joy
- Division of Pulmonary and Critical Care Medicine, Philippine Heart Center, Quezon City, Philippines
| | - Mona Sayed
- Nursing Medical Surgical Critical Care Department, Minia University, Minia, Egypt
| | - Juljani Sherwina
- Division of Pulmonary and Critical Care Medicine, Philippine Heart Center, Quezon City, Philippines
| | - Tamer Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Johannes J Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Drienerlolaan 5, 7522NB Enschede, the Netherlands
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2
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Wang Y, Abdelhafez YG, Spencer BA, Verma R, Parikh M, Stollenwerk N, Nardo L, Jones T, Badawi RD, Cherry SR, Wang G. High-Temporal-Resolution Kinetic Modeling of Lung Tumors with Dual-Blood Input Function Using Total-Body Dynamic PET. J Nucl Med 2024; 65:714-721. [PMID: 38548347 PMCID: PMC11064825 DOI: 10.2967/jnumed.123.267036] [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: 11/09/2023] [Revised: 02/21/2024] [Indexed: 05/03/2024] Open
Abstract
The lungs are supplied by both the pulmonary arteries carrying deoxygenated blood originating from the right ventricle and the bronchial arteries carrying oxygenated blood downstream from the left ventricle. However, this effect of dual blood supply has never been investigated using PET, partially because the temporal resolution of conventional dynamic PET scans is limited. The advent of PET scanners with a long axial field of view, such as the uEXPLORER total-body PET/CT system, permits dynamic imaging with high temporal resolution (HTR). In this work, we modeled the dual-blood input function (DBIF) and studied its impact on the kinetic quantification of normal lung tissue and lung tumors using HTR dynamic PET imaging. Methods: Thirteen healthy subjects and 6 cancer subjects with lung tumors underwent a dynamic 18F-FDG scan with the uEXPLORER for 1 h. Data were reconstructed into dynamic frames of 1 s in the early phase. Regional time-activity curves of lung tissue and tumors were analyzed using a 2-tissue compartmental model with 3 different input functions: the right ventricle input function, left ventricle input function, and proposed DBIF, all with time delay and dispersion corrections. These models were compared for time-activity curve fitting quality using the corrected Akaike information criterion and for differentiating lung tumors from lung tissue using the Mann-Whitney U test. Voxelwise multiparametric images by the DBIF model were further generated to verify the regional kinetic analysis. Results: The effect of dual blood supply was pronounced in the high-temporal-resolution time-activity curves of lung tumors. The DBIF model achieved better time-activity curve fitting than the other 2 single-input models according to the corrected Akaike information criterion. The estimated fraction of left ventricle input was low in normal lung tissue of healthy subjects but much higher in lung tumors (∼0.04 vs. ∼0.3, P < 0.0003). The DBIF model also showed better robustness in the difference in 18F-FDG net influx rate [Formula: see text] and delivery rate [Formula: see text] between lung tumors and normal lung tissue. Multiparametric imaging with the DBIF model further confirmed the differences in tracer kinetics between normal lung tissue and lung tumors. Conclusion: The effect of dual blood supply in the lungs was demonstrated using HTR dynamic imaging and compartmental modeling with the proposed DBIF model. The effect was small in lung tissue but nonnegligible in lung tumors. HTR dynamic imaging with total-body PET can offer a sensitive tool for investigating lung diseases.
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Affiliation(s)
- Yiran Wang
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Yasser G Abdelhafez
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
- Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Assiut, Egypt; and
| | - Benjamin A Spencer
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
| | - Rashmi Verma
- Comprehensive Cancer Center, University of California Davis Medical Center, Sacramento, California
| | - Mamta Parikh
- Comprehensive Cancer Center, University of California Davis Medical Center, Sacramento, California
| | - Nicholas Stollenwerk
- Comprehensive Cancer Center, University of California Davis Medical Center, Sacramento, California
| | - Lorenzo Nardo
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
| | - Terry Jones
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
| | - Ramsey D Badawi
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Simon R Cherry
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Guobao Wang
- Department of Radiology, University of California Davis Medical Center, Sacramento, California;
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Xu HD, Yang L, Hu SB. Embosphere microspheres size for bronchial artery embolization in patients with hemoptysis caused by bronchiectasis: a retrospective comparative analysis of 500-750 versus 700-900 μm microspheres. BMC Pulm Med 2024; 24:203. [PMID: 38658883 PMCID: PMC11044458 DOI: 10.1186/s12890-024-03019-4] [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: 09/27/2023] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Bronchial arterial embolization (BAE) has been accepted as an effective treatment for bronchiectasis-related hemoptysis. However, rare clinical trials compare different sizes of specific embolic agents. This study aims to evaluate whether different Embosphere microsphere sizes change the outcome of BAE. METHODS A retrospective review was conducted on consecutive patients with bronchiectatic hemoptysis who were scheduled to undergo BAE treatment during a period from January 2018 to December 2022. The patients received BAE using microspheres of different sizes: group A patients were treated with 500-750 μm microspheres, and group B patients were treated with 700-900 μm microspheres. The cost of embolic microspheres (Chinese Yuan, CNY), duration of hospitalization, complications, and hemoptysis-free survival were compared between patients in group A and those in group B. A Cox proportional hazards regression model was used to identify predictors of recurrent hemoptysis. RESULTS Median follow-up was 30.2 months (range, 20.3-56.5 months). The final analysis included a total of 112 patients (49-77 years of age; 45 men). The patients were divided into two groups: group A (N = 68), which received 500-750 μm Embosphere microspheres, and group B (N = 44), which received 700-900 μm Embosphere microspheres. Except for the cost of embolic microspheres(group A,5314.8 + 1301.5 CNY; group B, 3644.5 + 1192.3 CNY; p = 0.042), there were no statistically significant differences in duration of hospitalization (group A,7.2 + 1.4 days; group B, 8 + 2.4days; p = 0.550), hemoptysis-free survival (group A, 1-year, 2-year, 3-year, 85.9%, 75.8%, 62.9%; group B, 1-year, 2-year, 3-year, 88.4%, 81.2%,59.4%;P = 0.060), and complications(group A,26.5%; group B, 38.6%; p = 0.175) between the two groups. No major complications were observed. The multivariate analysis results revealed that the presence of cystic bronchiectasis (OR 1.61, 95% CI 1.12-2.83; P = 0.001) and systemic arterial-pulmonary shunts (SPSs) (OR 1.52, 95% CI 1.10-2.72; P = 0.028) were independent risk factors for recurrent bleeding. CONCLUSIONS For the treatment of BAE in patients with bronchiectasis-related hemoptysis, 500-750 μm diameter Embosphere microspheres have a similar efficacy and safety profile compared to 700-900 μm diameter Embosphere microspheres, especially for those without SPSs or cystic bronchiectasis. Furthermore, the utilization of large-sized (700-900 μm) Embosphere microspheres is associated with the reduced cost of an embolic agent.
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Affiliation(s)
- Hong-Dou Xu
- Department of Interventional Radiology, Gaochun Peoples Hospital Affiliated to Jiangsu University, 53 Maoshan Road, Gaochun District, Nanjing, 211302, Jiangsu, China
| | - Liang Yang
- Department of Interventional Radiology, Gaochun Peoples Hospital Affiliated to Jiangsu University, 53 Maoshan Road, Gaochun District, Nanjing, 211302, Jiangsu, China
| | - Shi-Bing Hu
- Department of Interventional Radiology, Gaochun Peoples Hospital Affiliated to Jiangsu University, 53 Maoshan Road, Gaochun District, Nanjing, 211302, Jiangsu, China.
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4
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Goffer EM, Lamberti KK, Spognardi AM, Edelman ER, Keller SP. Steady Flow Left Ventricle Unloading Is Superior to Pulsatile Pressure Augmentation Venting During Venoarterial Extracorporeal Membrane Oxygenation Support. ASAIO J 2024:00002480-990000000-00460. [PMID: 38588597 DOI: 10.1097/mat.0000000000002208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) shunts venous blood to the systemic arterial circulation to provide end-organ perfusion while increasing afterload that may impede left ventricle (LV) ejection and impair cardiac recovery. To maintain flow across the aortic valve and reduce risk of lethal clot formation, secondary mechanical circulatory support (MCS) devices are increasingly used despite limited understanding of their effects on cardiac function. This study sought to quantify the effects of VA-ECMO and combined with either intraaortic balloon pump (IABP) or percutaneous ventricular assist device (pVAD) on LV physiologic state and perfusion metrics in a porcine model of acute cardiogenic shock. Shock was induced through serial left anterior descending artery microbead embolization followed by initiation of VA-ECMO support and then placement of either IABP or pVAD. Hemodynamic measurements, LV pressure-volume loops, and carotid artery blood flow were evaluated before and after institution of combined MCS. The IABP decreased LV end-diastolic pressure by a peak of 15% while slightly increasing LV stroke work compared with decreases of more than 60% and 50% with the pVAD, respectively. The pVAD also demonstrated increased coronary perfusion and systemic pressure gradients in comparison to the IABP. Combined support with VA-ECMO and pVAD improves cardiovascular state in comparison to IABP.
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Affiliation(s)
- Efrat M Goffer
- From the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Kimberly K Lamberti
- From the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | - Elazer R Edelman
- From the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Steven P Keller
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
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Seo W, Kim HW, Kim JS, Min J. Long term management of people with post-tuberculosis lung disease. Korean J Intern Med 2024; 39:7-24. [PMID: 38225822 PMCID: PMC10790047 DOI: 10.3904/kjim.2023.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 01/17/2024] Open
Abstract
Post-tuberculosis lung disease (PTLD) is emerging as a significant area of global interest. As the number of patients surviving tuberculosis (TB) increases, the subsequent long-term repercussions have drawn increased attention due to their profound clinical and socioeconomic impacts. A primary obstacle to its comprehensive study has been its marked heterogeneity. The disease presents a spectrum of clinical manifestations which encompass tracheobronchial stenosis, bronchiectasis, granulomas with fibrosis, cavitation with associated aspergillosis, chronic pleural diseases, and small airway diseases-all persistent consequences of PTLD. The spectrum of symptoms a patient may experience varies based on the severity of the initial infection and the efficacy of the treatment received. As a result, the long-term management of PTLD necessitates a detailed and specific approach, addressing each manifestation individually-a tailored strategy. In the immediate aftermath (0-12 months after anti-TB chemotherapy), there should be an emphasis on monitoring for relapse, tracheobronchial stenosis, and smoking cessation. Subsequent management should focus on addressing hemoptysis, managing infection including aspergillosis, and TB-associated chronic obstructive pulmonary disease or restrictive lung function. There remains a vast expanse of knowledge to be discovered in PTLD. This review emphasizes the pressing need for comprehensive, consolidated guidelines for management of patients with PTLD.
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Affiliation(s)
- Wan Seo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hyung Woo Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Ju Sang Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jinsoo Min
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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Wang M, Jia S, Pu X, Sun L, Liu Y, Gong M, Zhang H. A scoring model based on clinical factors to predict postoperative moderate to severe acute respiratory distress syndrome in Stanford type A aortic dissection. BMC Pulm Med 2023; 23:515. [PMID: 38129835 PMCID: PMC10734156 DOI: 10.1186/s12890-023-02736-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/26/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Postoperative acute respiratory distress syndrome (ARDS) after type A aortic dissection is common and has high mortality. However, it is not clear which patients are at high risk of ARDS and an early prediction model is deficient. METHODS From May 2015 to December 2017, 594 acute Stanford type A aortic dissection (ATAAD) patients who underwent aortic surgery in Anzhen Hospital were enrolled in our study. We compared the early survival of MS-ARDS within 24 h by Kaplan-Meier curves and log-rank tests. The data were divided into a training set and a test set at a ratio of 7:3. We established two prediction models and tested their efficiency. RESULTS The oxygenation index decreased significantly immediately and 24 h after TAAD surgery. A total of 363 patients (61.1%) suffered from moderate and severe hypoxemia within 4 h, and 243 patients (40.9%) suffered from MS-ARDS within 24 h after surgery. Patients with MS-ARDS had higher 30-day mortality than others (log-rank test: p-value <0.001). There were 30 variables associated with MS-ARDS after surgery. The XGboost model consisted of 30 variables. The logistic regression model (LRM) consisted of 11 variables. The mean accuracy of the XGBoost model was 70.7%, and that of the LRM was 80.0%. The AUCs of XGBoost and LRM were 0.764 and 0.797, respectively. CONCLUSION Postoperative MS-ARDS significantly increased early mortality after TAAD surgery. The LRM model has higher accuracy, and the XGBoost model has higher specificity.
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Affiliation(s)
- Maozhou Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Songhao Jia
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Pu
- Department of Interventional Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lizhong Sun
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuyong Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Ming Gong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Hongjia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Wang F, Tang J, Peng M, Huang PJ, Zhao LJ, Zhang YY, Wang T. Recurrent hemoptysis in pediatric bronchial Dieulafoy's disease with inferior phrenic artery supply: A case report. World J Clin Cases 2023; 11:6268-6273. [PMID: 37731559 PMCID: PMC10507539 DOI: 10.12998/wjcc.v11.i26.6268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Bronchial Dieulafoy's disease (BDD) is characterized by the erosion of an anomalous artery in the submucosa of the bronchus. The etiology of pediatric BDD is mainly congenital dysplasia of bronchus and pulmonary arteries, which is different from chronic inflammatory injury of the airway in adult patients. The internal thoracic artery, subclavian artery, and intercostal artery are known to be involved in the blood supply to the BDD lesion in children. CASE SUMMARY We report a case of BDD in a 4-year-old boy with recurrent hemoptysis for one year. Selective angiography showed a dilated right bronchial artery, and anastomosis of its branches with the right lower pulmonary vascular network. Bronchoscopy showed nodular protrusion of the bronchial mucosa with a local scar. Selective embolization of the bronchial artery was performed to stop bleeding. One month after the first intervention, the symptoms of hemoptysis recurred. A computed tomography angiogram (CTA) showed another tortuous and dilated feeding artery in the right lower lung, which was an abnormal ascending branch of the inferior phrenic artery (IPA). The results of angiography were consistent with the CTA findings. The IPA was found to be another main supplying artery, which was not considered during the first intervention. Finally, the IPA was also treated by microsphere embolization combined with coil interventional closure. During the one-year follow-up, the patient never experienced hemoptysis. CONCLUSION The supplying arteries of the bleeding lesion in children with BDD may originate from multiple different aortopulmonary collateral arteries, and the IPA should be considered to reduce missed diagnosis. CTA is a noninvasive radiological examination for the screening of suspected vessels, which shows a high coincidence with angiography, and can serve as the first choice for the diagnosis of BDD.
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Affiliation(s)
- Fang Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jiao Tang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Pediatrics, The First People's Hospital of Longquanyi District, Chengdu 610041, Sichuan Province, China
| | - Mou Peng
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Pu-Jue Huang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Pediatrics, The First People's Hospital of Longquanyi District, Chengdu 610041, Sichuan Province, China
| | - Li-Juan Zhao
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Pediatrics, Western Theater General Hospital, Chengdu 610041, Sichuan Province, China
| | - Yin-Yue Zhang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tao Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, Chengdu 610041, Sichuan Province, China
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Cao Z, Zhao Y, Sun H, Sun X, Zhang Y, Zhang S, Wang C, Xiong T, Naeem A, Zhang J, Yin X. Cross-scale tracing of nanoparticles and tumors at the single-cell level using the whole-lung atlas. SCIENCE ADVANCES 2023; 9:eadh7779. [PMID: 37531437 PMCID: PMC10396308 DOI: 10.1126/sciadv.adh7779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/30/2023] [Indexed: 08/04/2023]
Abstract
Currently, the effectiveness of oncotherapy is limited by tumor heterogeneities, which presents a huge challenge for the development of nanotargeted drug delivery systems (DDSs). Therefore, it is important to resolve the spatiotemporal interactions between tumors and nanoparticles. However, targeting evaluation has been limited by particle visualization due to the gap between whole-organ scale and subcellular precision. Here, a high-precision three-dimensional (3D) visualization of tumor structure based on the micro-optical sectioning tomography (MOST) system and fluorescence MOST (fMOST) system is presented to clarify 3D spatial distribution of nanoparticles within the tumor. We demonstrate that through the MOST/fMOST system, it is possible to reveal multidimensional and cross-scale correlations between the tumor structure and nanoparticle distribution to remodel the tumor microenvironment and explore the structural parameters of vasculature. This visualization methodology provides an accurate assessment of the efficacy, distribution, and targeting efficiency of DDSs for oncotherapy compared to available approaches.
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Affiliation(s)
- Zeying Cao
- Center for Drug Delivery System, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yanli Zhao
- Lingang Laboratory, Shanghai 201602, China
| | - Hongyu Sun
- Center for Drug Delivery System, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Xian Sun
- Center for MOST and Image Fusion Analysis, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201210, China
| | - Yu Zhang
- Center for MOST and Image Fusion Analysis, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201210, China
| | - Shuo Zhang
- Lingang Laboratory, Shanghai 201602, China
| | - Caifen Wang
- Center for Drug Delivery System, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Ting Xiong
- Center for Drug Delivery System, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- College of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Abid Naeem
- Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, China
| | - Jiwen Zhang
- Center for Drug Delivery System, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- University of Chinese Academy of Sciences, Beijing 100049, China
- College of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
- Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, China
- NMPA Key Laboratory for Quality Research and Evaluation of Pharmaceutical Excipients, National Institutes for Food and Drug Control, Beijing 100050, China
| | - Xianzhen Yin
- Lingang Laboratory, Shanghai 201602, China
- Center for MOST and Image Fusion Analysis, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201210, China
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Daboussi S, Kacem M, Boubaker N, Chaabene M, Aichaouia C, Mhamdi S, Moatemri Z. Dieulafoy's disease of the bronchus: rare but potentially fatal: a case report and a review of literature. J Cardiothorac Surg 2023; 18:207. [PMID: 37403165 DOI: 10.1186/s13019-023-02242-0] [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: 10/08/2022] [Accepted: 04/02/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Dieulafoy's disease of the bronchus can cause massive and even fatal hemoptysis. Even though it is rare, it should be considered by physicians all over the world. This paper reports a case of bronchial Dieulafoy's disease and summarizes the data of similar cases reported in literature. METHODS We report a case of bronchial Dieulafoy's disease (BDD) in Tunisia. We also present a review of literature related to BDD from 1995 to 2022 using the PubMed, Google Scholar, web of science and Chinese National Knowledge Infrastructure Databases. Clinical characteristics, chest imaging, bronchoscopic and angiographic findings were summarized. Treatment courses were identified as well as patients' outcome. RESULTS We report the case of a 41-year-old man, so far in good health, presenting with massive hemoptysis. Bronchoscopy showed blood clots and a protruding lesion covered by mucosa with a white pointed cap at the entrance of the right upper lobe. Biopsies were not attempted. Embolization of bronchial artery was first realized and was not successful, with post procedure complications. Surgical intervention stopped the bleeding and pathological examination of the resected specimen confirmed Dieulafoy's disease of the bronchus. Ninety cases of BDD were reported from 1995 to 2022. The main symptom was hemoptysis. Chest imaging findings were not specific. The diagnosis of BDD was mainly based on the bronchoscopy, branchial angiography and pathological findings or surgical specimens. Bronchoscopy findings were mostly nodular or prominent lesions (52.4%). Twenty-eight patients underwent bronchoscopic biopsies, 20 had massive bleeding and 10 died. Bronchial angiography mainly showed tortuous and dilation of bronchial artery, and the lesions were mainly located in the right bronchus. Selective bronchial artery embolization (SBAE) was performed in 32 patients and 39 patients underwent surgery. CONCLUSION To our knowledge, this is the first case of bronchial Dieulafoy's disease to be reported in Tunisia and North Africa. When the diagnosis is suspected, bronchoscopic biopsy should be avoided as it might lead to fatal hemorrhage. Selective bronchial artery embolization can stop the bleeding, but surgery can be required.
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Affiliation(s)
- Salsabil Daboussi
- The pulmonology department of the military hospital of Tunis, Tunis, Tunisia.
| | - Marwa Kacem
- The pulmonology department of the military hospital of Tunis, Tunis, Tunisia
| | - Nouha Boubaker
- The pulmonology department of the military hospital of Tunis, Tunis, Tunisia
| | - Mariem Chaabene
- The pulmonology department of the military hospital of Tunis, Tunis, Tunisia
| | - Chiraz Aichaouia
- The pulmonology department of the military hospital of Tunis, Tunis, Tunisia
| | - Samira Mhamdi
- The pulmonology department of the military hospital of Tunis, Tunis, Tunisia
| | - Zied Moatemri
- The pulmonology department of the military hospital of Tunis, Tunis, Tunisia
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10
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Wang Y, Spencer BA, Schmall J, Li E, Badawi RD, Jones T, Cherry SR, Wang G. High-Temporal-Resolution Lung Kinetic Modeling Using Total-Body Dynamic PET with Time-Delay and Dispersion Corrections. J Nucl Med 2023; 64:1154-1161. [PMID: 37116916 PMCID: PMC10315691 DOI: 10.2967/jnumed.122.264810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/22/2023] [Indexed: 04/30/2023] Open
Abstract
Tracer kinetic modeling in dynamic PET has the potential to improve the diagnosis, prognosis, and research of lung diseases. The advent of total-body PET systems with much greater detection sensitivity enables high-temporal-resolution (HTR) dynamic PET imaging of the lungs. However, existing models may become insufficient for modeling the HTR data. In this paper, we investigate the necessity of additional corrections to the input function for HTR lung kinetic modeling. Methods: Dynamic scans with HTR frames of as short as 1 s were performed on 13 healthy subjects with a bolus injection of about [Formula: see text] of 18F-FDG using the uEXPLORER total-body PET/CT system. Three kinetic models with and without time-delay and dispersion corrections were compared for the quality of lung time-activity curve fitting using the Akaike information criterion. The impact on quantification of 18F-FDG delivery rate [Formula: see text], net influx rate [Formula: see text] and fractional blood volume [Formula: see text] was assessed. Parameter identifiability analysis was also performed to evaluate the reliability of kinetic quantification with respect to noise. Correlation of kinetic parameters with age was investigated. Results: HTR dynamic imaging clearly revealed the rapid change in tracer concentration in the lungs and blood supply (i.e., the right ventricle). The uncorrected input function led to poor time-activity curve fitting and biased quantification in HTR kinetic modeling. The fitting was improved by time-delay and dispersion corrections. The proposed model resulted in an approximately 85% decrease in [Formula: see text], an approximately 75% increase in [Formula: see text], and a more reasonable [Formula: see text] (∼0.14) than the uncorrected model (∼0.04). The identifiability analysis showed that the proposed models had good quantification stability for [Formula: see text], [Formula: see text], and [Formula: see text] The [Formula: see text] estimated by the proposed model with simultaneous time-delay and dispersion corrections correlated inversely with age, as would be expected. Conclusion: Corrections to the input function are important for accurate lung kinetic analysis of HTR dynamic PET data. The modeling of both delay and dispersion can improve model fitting and significantly impact quantification of [Formula: see text], [Formula: see text], and [Formula: see text].
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Affiliation(s)
- Yiran Wang
- Department of Radiology, University of California Davis Medical Center, Sacramento, California;
- Department of Biomedical Engineering, University of California at Davis, Davis, California; and
| | - Benjamin A Spencer
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
- Department of Biomedical Engineering, University of California at Davis, Davis, California; and
| | | | - Elizabeth Li
- Department of Biomedical Engineering, University of California at Davis, Davis, California; and
| | - Ramsey D Badawi
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
- Department of Biomedical Engineering, University of California at Davis, Davis, California; and
| | - Terry Jones
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
| | - Simon R Cherry
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
- Department of Biomedical Engineering, University of California at Davis, Davis, California; and
| | - Guobao Wang
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
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11
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Herrera DG, Ostad BJ, Wilkins LR, Sheeran DP, Park AW, Goode AR, Patrie JT, Angle JF. Effect of computed tomography angiography prior to bronchial embolization on radiation dose and recurrent hemoptysis. Clin Imaging 2023; 100:48-53. [PMID: 37207442 DOI: 10.1016/j.clinimag.2023.04.007] [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: 11/15/2022] [Revised: 03/10/2023] [Accepted: 04/13/2023] [Indexed: 05/21/2023]
Abstract
PURPOSE To investigate whether pre-procedure Computed Tomography Angiography (CTA) improves radiation exposure, procedure complexity, and symptom recurrence after bronchial embolization for massive hemoptysis. MATERIAL AND METHODS A single-center retrospective review of bronchial artery embolization (BAE) for massive hemoptysis was performed for procedures between 2008 and 2019. Multi-variate analysis was performed to determine the significance of pre-procedure CTA and etiology of hemoptysis on patient radiation exposure (reference point air kerma, RPAK) and rate of recurrent hemoptysis. RESULTS There were 61 patients (mean age 52.5 years; SD = 19.2 years, and 57.3% male) and CTA was obtained for 42.6% (26/61). Number of vessels selected was a mean of 7.2 (SD = 3.4) in those without CTA and 7.4 (SD = 3.4) in those with CTA (p = 0.923). Mean procedure duration was 1.8 h (SD = 1.6 h) in those without CTA and 1.3 h (SD = 1.0 h) in those with CTA (p = 0.466). Mean fluoroscopy time and RPAK per procedure were 34.9 min (SD = 21.5 min) and 1091.7 mGy (SD = 1316.6 mGy) for those without a CTA and 30.7 min (SD = 30.7 min) and 771.5 mGy (SD = 590.0 mGy) for those with a CTA (p = 0.523, and p = 0.879, respectively). Mean total iodine given was 49.2 g (SD = 31.9 g) for those without a CTA and 70.6 g (SD = 24.9 g) for those with a CTA (p = 0.001). Ongoing hemoptysis at last clinical follow up was 13/35 (37.1%) in those without CTA and 9/26 (34.6%) in those with CTA (p = 0.794). CONCLUSIONS Pre-procedure CTA did not improve radiation effective dose and symptom recurrence after BAE and is associated with significant increases in total iodine dose.
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Affiliation(s)
- Daniel Giraldo Herrera
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America.
| | - Bahrom J Ostad
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
| | - Luke R Wilkins
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
| | - Daniel P Sheeran
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
| | - Auh Whan Park
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
| | - Allen R Goode
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Diagnostic Medical Physics, United States of America
| | - James T Patrie
- University of Virginia School of Medicine, Department of Public Health Sciences, United States of America
| | - John F Angle
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
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12
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Zhou C, Song S, Fu JF, Zhao XL, Liu HQ, Pei HS, Guo HB. Continuous positive airway pressure for treating hypoxemia due to pulmonary vein injury: A case report. World J Clin Cases 2023; 11:1830-1836. [PMID: 36969990 PMCID: PMC10037272 DOI: 10.12998/wjcc.v11.i8.1830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/25/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Vascular injury during thoracoscopic surgery for esophageal cancer is a rare but life-threatening complication that can lead to severe hypotension and hypoxemia. Anesthesiologists need to provide rapid and effective treatment to save patients' lives.
CASE SUMMARY A 54-year-old male patient was scheduled to undergo a thoracoscopic-assisted radical resection of esophageal cancer through the upper abdomen and right chest. While dissociating the esophagus from the carina through the right chest, unexpected profuse bleeding occurred from a suspected pulmonary vascular hemorrhage. While the surgeon attempted to achieve hemostasis, the patient developed severe hypoxemia. The anesthesiologist implemented continuous positive airway pressure (CPAP) using a bronchial blocker (BB), which effectively improved the patient’s oxygenation and the operation was completed successfully.
CONCLUSION CPAP using a BB can resolve severe hypoxemia caused by accidental injury of the left inferior pulmonary vein during surgery.
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Affiliation(s)
- Chao Zhou
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050001, Hebei Province, China
| | - Shan Song
- Department of Respiratory, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Jian-Feng Fu
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050001, Hebei Province, China
| | - Xue-Lian Zhao
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050001, Hebei Province, China
| | - Hua-Qin Liu
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050001, Hebei Province, China
| | - Huan-Shuang Pei
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050001, Hebei Province, China
| | - Hong-Bo Guo
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050001, Hebei Province, China
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13
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Update on the roles of imaging in the management of chronic thromboembolic pulmonary hypertension. J Cardiol 2023; 81:297-306. [PMID: 35490106 DOI: 10.1016/j.jjcc.2022.03.001] [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: 02/18/2022] [Accepted: 03/02/2022] [Indexed: 02/01/2023]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH), classified as group 4 pulmonary hypertension (PH), is caused by stenosis and obstruction of the pulmonary arteries by organized thrombi that are incompletely resolved after acute pulmonary embolism. The prognosis of patients with CTEPH is poor if untreated; however, in expert centers with multidisciplinary teams, a treatment strategy for CTEPH has been established, dramatically improving its prognosis. CTEPH is currently not a fatal disease and is the only curable form of PH. Despite these advances and the establishment of treatment approaches, early diagnosis is still challenging, especially for non-experts, for several reasons. One of the reasons for this is insufficient knowledge of the various diagnostic imaging modalities, which are essential in the clinical practice of CTEPH. Imaging modalities should detect the following pathological findings: lung perfusion defects, thromboembolic lesions in pulmonary arteries, and right ventricular remodeling and dysfunction. Perfusion lung scintigraphy and catheter angiography have long been considered gold standards for the detection of perfusion defects and assessment of vascular lesions, respectively. However, advances in imaging technology of computed tomography and magnetic resonance imaging have enabled the non-invasive detection of these abnormal findings in a single examination. Cardiac magnetic resonance (CMR) is the gold standard for evaluating the morphology and function of the right heart; however, state-of-the-art techniques in CMR allow the assessment of cardiac tissue characterization and hemodynamics in the pulmonary arteries. Comprehensive knowledge of the role of imaging in CTEPH enables appropriate use of imaging modalities and accurate image interpretation, resulting in early diagnosis, determination of treatment strategies, and appropriate evaluation of treatment efficacy. This review summarizes the current roles of imaging in the clinical practice for CTEPH, demonstrating the characteristic findings observed in each modality.
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14
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Chen O, Ye L, Zhang L, Hu B. Abnormal bronchial artery mimicking esophageal submucosal tumor. Endoscopy 2023; 55:E462-E463. [PMID: 36828020 PMCID: PMC9957670 DOI: 10.1055/a-2018-4127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Ou Chen
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China,Department of Gastroenterology, Ya’an People’s Hospital, Ya’an, China
| | - Liansong Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Zhang
- Department of Radiology, Ya’an People’s Hospital, Ya’an, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
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15
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Mitchell SE, Martin RP, Terry P, Drant SE, Valle D, Dietz H, Sobreira N. Systemic artery to pulmonary artery aneurysm malformations associated with variants at MCF2L. Am J Med Genet A 2023; 191:1250-1260. [PMID: 36760094 DOI: 10.1002/ajmg.a.63141] [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: 10/31/2022] [Revised: 12/23/2022] [Accepted: 01/14/2023] [Indexed: 02/11/2023]
Abstract
Arteriovenous malformations (AVM) are characterized by abnormal vessels connecting arteries and veins resulting in a disruption of normal blood flow. Hereditary hemorrhagic telangiectasia (HHT) is the most common cause of pulmonary AVM characterized by a right to left shunt. Here we describe a distinct malformation where the flow of blood was from a systemic artery to the pulmonary artery (PA) resulting in a left to right shunt instead of the right to left shunt seen in individuals with HHT. This distinct malformation was identified in seven probands, one from a multiplex family containing 10 affected individuals from five generations. To identify the molecular basis of this distinct malformation, we performed exome sequencing (ES) on the seven probands and the affected paternal female cousin from the multiplex family. PhenoDB was used to prioritize candidate causative variants along with burden analysis. We describe the clinical and radiological details of the new systemic artery to PA malformation with or without pulmonary artery aneurysm (SA-PA(A)) and recommend distinct treatment techniques. Moreover, ES analysis revealed possible causative variants identified in three families with variants in a novel candidate disease gene, MCF2L. Further functional studies will be necessary to better understand the molecular mechanisms involved on SA-PA(A) malformation, however our findings suggest that MCF2L is a novel disease gene associated with SA-PA(A).
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Affiliation(s)
- S E Mitchell
- Russell H Morgan Department of Radiology, Interventional Section, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R P Martin
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - P Terry
- Pulmonary Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S E Drant
- Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - D Valle
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - H Dietz
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Sobreira
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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16
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Yu J, Xu C, Wen Z, Wang G, Gil Silva AA, Brown MJ, Sanchez PG, Wang X. Shock lung is not "wet" but characterized as necroptotic inflammation in a mouse model of hypotension. J Thorac Cardiovasc Surg 2023; 165:e40-e53. [PMID: 35850733 DOI: 10.1016/j.jtcvs.2022.06.011] [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: 12/20/2021] [Revised: 04/21/2022] [Accepted: 06/17/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Hypotension episodes before or after donor brain death are assumed to trigger hypoxia-reoxygenation, causing diffuse alveolar-capillary damage via necrosis. However, alveolar-capillary membranes have direct access to oxygen in alveoli. We hypothesized hypotension-induced lung injury is not diffuse alveolar-capillary damage but interstitial inflammation resulting from nonhypoxic lung ischemia and systemic responses to hypoxic extrapulmonary ischemia. METHODS The 4-hour hypotension model was established by subjecting C57BL/6J mice to 4-hour hypotension at 15 ± 5 mm Hg of mean artery pressure and resuscitated with whole shed blood and norepinephrine. Nonhypoxic lung ischemia model was established by 4-hour left pulmonary artery ligation. At 24 hours postprocedure, an arterial blood gas analysis and a gastroduodenal occult blood test were conducted. Lung samples were assessed for histology, cytokine transcripts, regulated cell death, and alveolar-capillary permeability. RESULTS The 4-hour hypotension model had an intraoperative mortality rate of 17.7% (41/231) and a stress-ulcer bleeding rate of 15.3% (29/190). No signs of alveolar flooding were observed in both models. Four-hour hypotension without stress ulcer showed normal oxygenation and permeability but increased interstitial infiltration, transcription of Tnf and Il1b, phosphorylation of MLKL and RIPK3, and cleaved caspase 3 compared with 4-hour pulmonary artery ligation and naïve control. Animals that developed stress ulcer presented with worse pulmonary infiltration, intracellular edema, and oxygenation but just slightly increased permeability. Immunoblotting showed significant upregulations of protein expression and phosphorylation of MLKL and RIPK3, cleaved Caspase-3, but not its prototype in 4-hour hypotension with stress ulcer. CONCLUSIONS Hypotensive lung injury is essentially a nonhypoxic ischemia-reperfusion injury enhanced by systemic responses. It is predominated by necroptosis-induced inflammation rather than necrosis-induced diffuse alveolar-capillary damage.
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Affiliation(s)
- Junyi Yu
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pa; Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, Pa; Department of Breast Neoplastic Surgery (25th Ward), Hunan Tumor Hospital, The Affiliated Tumor Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Che Xu
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pa; Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, Pa; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zongmei Wen
- Department of Anesthesia, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guifang Wang
- Department of Respiratory Medicine, Huashan Hospital, Fudan University School of Medicine, Shanghai, China
| | - Agustin Alejandro Gil Silva
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Mark J Brown
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Xingan Wang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pa; Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, Pa; Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
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17
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Phantom-Less Nonlinear Magnetic Resonance Imaging Calibration With Multiple Input Blood Flow Model. Top Magn Reson Imaging 2023; 32:5-13. [PMID: 36735623 DOI: 10.1097/rmr.0000000000000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/08/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Previous work used phantoms to calibrate the nonlinear relationship between the gadolinium contrast concentration and the intensity of the magnetic resonance imaging signal. This work proposes a new nonlinear calibration procedure without phantoms and considers the variation of contrast agent mass minimum combined with the multiple input blood flow system. This also proposes a new single-input method with meaningful variables that is not influenced by reperfusion or noise generated by aliasing. The reperfusion in the lung is usually neglected and is not considered by the indicator dilution method. However, in cases of lung cancer, reperfusion cannot be neglected. A new multiple input method is formulated, and the contribution of the pulmonary artery and bronchial artery to lung perfusion can be considered and evaluated separately. METHODS The calibration procedure applies the minimum variation of contrast agent mass in 3 different regions: (1) pulmonary artery, (2) left atrium, and (3) aorta. It was compared with four dimensional computerized tomography with iodine, which has a very high proportional relationship between contrast agent concentration and signal intensity. RESULTS Nonlinear calibration was performed without phantoms, and it is in the range of phantom calibration. It successfully separated the contributions of the pulmonary and bronchial arteries. The proposed multiple input method was verified in 6 subjects with lung cancer, and perfusion from the bronchial artery, rich in oxygen, was identified as very high in the cancer region. CONCLUSIONS Nonlinear calibration of the contrast agent without phantoms is possible. Separate contributions of the pulmonary artery and aorta can be determined.
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18
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Mohanka M, Banga A. Alterations in Pulmonary Physiology with Lung Transplantation. Compr Physiol 2023; 13:4269-4293. [PMID: 36715279 DOI: 10.1002/cphy.c220008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Lung transplant is a treatment option for patients with end-stage lung diseases; however, survival outcomes continue to be inferior when compared to other solid organs. We review the several anatomic and physiologic changes that result from lung transplantation surgery, and their role in the pathophysiology of common complications encountered by lung recipients. The loss of bronchial circulation into the allograft after transplant surgery results in ischemia-related changes in the bronchial artery territory of the allograft. We discuss the role of bronchopulmonary anastomosis in blood circulation in the allograft posttransplant. We review commonly encountered complications related to loss of bronchial circulation such as allograft airway ischemia, necrosis, anastomotic dehiscence, mucociliary dysfunction, and bronchial stenosis. Loss of dual circulation to the lung also increases the risk of pulmonary infarction with acute pulmonary embolism. The loss of lymphatic drainage during transplant surgery also impairs the management of allograft interstitial fluid, resulting in pulmonary edema and early pleural effusion. We discuss the role of lymphatic drainage in primary graft dysfunction. Besides, we review the association of late posttransplant pleural effusion with complications such as acute rejection. We then review the impact of loss of afferent and efferent innervation from the allograft on control of breathing, as well as lung protective reflexes. We conclude with discussion about pulmonary function testing, allograft monitoring with spirometry, and classification of chronic lung allograft dysfunction phenotypes based on total lung capacity measurements. We also review factors limiting physical exercise capacity after lung transplantation, especially impairment of muscle metabolism. © 2023 American Physiological Society. Compr Physiol 13:4269-4293, 2023.
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Affiliation(s)
- Manish Mohanka
- Pulmonary and Critical Care Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Amit Banga
- Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, California, USA
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19
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An J, Dong Y, Niu H. Application of the 5F JL4 Catheter in Bronchial Artery Embolization With the Opening in the Inferior Wall of the Aortic Arch. Vasc Endovascular Surg 2023; 57:379-385. [PMID: 36597616 DOI: 10.1177/15385744221149910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND We investigated the efficacy and safety of bronchial artery embolization (BAE) using a 5F JL4 catheter in patients with hemoptysis and a bronchial artery opening in the inferior wall of the aortic arch. METHODS This was a single-center retrospective study. Seventeen patients underwent BAE using 5F JL4. We then evaluated technical success (TS), clinical success (CS), incidence of complications, and hemoptysis recurrence rate (RR). RESULTS The TS rate of microcatheter superselective catheterization and CS rate after surgery were 100%, and the incidence of severe complications and postoperative RR were 17.6%. CONCLUSIONS Bronchial artery embolization for hemoptysis with a BA opening in the inferior wall of the aortic arch using the 5F JL4 catheter could be a safe method. The short- and medium-term results were excellent.
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Affiliation(s)
- Jianli An
- Department of Interventional Treatment, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, PR China
| | - Yanchao Dong
- Department of Interventional Treatment, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, PR China
| | - Hongtao Niu
- Department of Interventional Treatment, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, PR China
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20
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Engelbrecht E, Kooistra T, Knipe RS. The Vasculature in Pulmonary Fibrosis. CURRENT TISSUE MICROENVIRONMENT REPORTS 2022; 3:83-97. [PMID: 36712832 PMCID: PMC9881604 DOI: 10.1007/s43152-022-00040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 02/02/2023]
Abstract
Purpose of Review The current paradigm of idiopathic pulmonary fibrosis (IPF) pathogenesis involves recurrent injury to a sensitive alveolar epithelium followed by impaired repair responses marked by fibroblast activation and deposition of extracellular matrix. Multiple cell types are involved in this response with potential roles suggested by advances in single-cell RNA sequencing and lung developmental biology. Notably, recent work has better characterized the cell types present in the pulmonary endothelium and identified vascular changes in patients with IPF. Recent Findings Lung tissue from patients with IPF has been examined at single-cell resolution, revealing reductions in lung capillary cells and expansion of a population of vascular cells expressing markers associated with bronchial endothelium. In addition, pre-clinical models have demonstrated a fundamental role for aging and vascular permeability in the development of pulmonary fibrosis. Summary Mounting evidence suggests that the endothelium undergoes changes in the context of fibrosis, and these changes may contribute to the development and/or progression of pulmonary fibrosis. Additional studies will be needed to further define the functional role of these vascular changes.
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Affiliation(s)
| | - Tristan Kooistra
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rachel S. Knipe
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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21
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Nezami N, Georgiades C, Hong KK, Buethe J. Bronchial Artery Chemoembolization With Radiopaque Doxorubicin Eluding Beads in Patients With Malignant Hemoptysis from Metastatic Lung Cancer. Technol Cancer Res Treat 2022; 21:15330338221131167. [PMID: 36226988 PMCID: PMC9577079 DOI: 10.1177/15330338221131167] [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: 11/06/2022] Open
Abstract
Purpose:This pilot study was designed to assess the technical feasibility and safety of bronchial artery chemoembolization with radiopaque doxorubicin eluting beads (DEB-BACE) in patients with malignant hemoptysis from pulmonary metastasis. Materials & Methods: Four patients underwent DEB-BACE using 70-150 μm radiopaque DEB (LC Beads LUMI, Boston Scientific). Beads delivery and deposition were assessed under fluoroscopy and cone beam computed tomography (CT), respectively. Results: All 4 procedures were technically successful. Beads delivery and deposition were successfully visualized under fluoroscopy and cone beam CT guidance in all cases. Hemoptysis was resolved after embolization in all 4 patients. There were no adverse events or immediate or early complications after DEB-BACE. Two patients (50%) required repeat DEB-BACE within 1 week due to recurrent hemoptysis, and 1 patient had DEB-BACE 1.5 years later due to recurrent hemoptysis from the contralateral lung. All targeted lesions decreased in size in follow-up studies (mean 16 months, range 1-33 months). One patient died of progressive cancer disease invading the heart 1 month after DEB-BACE. Conclusions: DEB-BACE using radiopaque LC Beads LUMI loaded with doxorubicin is technically feasible and safe for controlling hemoptysis and cancer progression in patients with metastatic lung tumors. Visualization of beads delivery under fluoroscopy and deposition of beads under cone beam CT facilitate delivery of beads and embolization of bronchial arteries.
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Affiliation(s)
- Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of
Diagnostic Radiology and Nuclear Medicine, University of Maryland School of
Medicine, Baltimore, MD, USA,Experimental Therapeutics Program, University of Maryland Marlene
and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA,Ji Buethe, MD, Division of Vascular and
Interventional Radiology, Department of Radiology and Radiological Sciences,
Johns Hopkins Hospital, 1800 Orleans, Suite 7203, Baltimore, MD 21287, USA.
| | - Christos Georgiades
- Division of Vascular and Interventional Radiology, Department of
Radiology and Radiological Sciences, the Johns Hopkins Hospital, Baltimore, MD,
USA
| | - Kelvin K. Hong
- Division of Vascular and Interventional Radiology, Department of
Radiology and Radiological Sciences, the Johns Hopkins Hospital, Baltimore, MD,
USA
| | - Ji Buethe
- Division of Vascular and Interventional Radiology, Department of
Radiology and Radiological Sciences, the Johns Hopkins Hospital, Baltimore, MD,
USA
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22
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Lee JH, Yoon CJ, Jung YS, Choi WS, Lee CH, Lee GM. Comparison of n-butyl-2-cyanoacrylate and polyvinyl alcohol particles for bronchial artery embolisation in primary lung cancer: a retrospective cohort study. Respir Res 2022; 23:257. [PMID: 36127690 PMCID: PMC9487124 DOI: 10.1186/s12931-022-02183-7] [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: 02/14/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bronchial artery embolisation (BAE) is an effective treatment option to control haemoptysis in primary lung cancer. However, no studies have investigated optimal embolisation material for BAE in lung cancer patients. Thus, this study aimed to compare the safety and efficacy of BAE performed using n-butyl-2-cyanoacrylate (NBCA) and polyvinyl alcohol (PVA) particles in primary lung cancer patients to determine which embolic material is better for patients with haemoptysis. METHODS This retrospective study was approved by the institutional review board, and consent was waived. The rates of hemostasis, complications, procedure time, dose-area product, and haemoptysis-free survival were retrospectively compared between primary lung cancer (non-small cell [n = 111] and small cell [n = 11]) patients who underwent BAE using NBCA (n = 58) or PVA particles (n = 64) between January 2004 and December 2019. Predictors of recurrent haemoptysis were analysed using the Cox proportional hazard regression model. RESULTS Among 122 patients (mean age, 66 ± 10 years; range 32-86 years; 103 men), more patients in the NBCA group (81.0%; 47 of 58) achieved complete hemostasis than did patients in the PVA group (53.1%; 34 of 64) (P = 0.002). No major complications were observed in either group. The procedure time (36.4 ± 21.6 vs. 56.3 ± 27.4 min, P < 0.001) was shorter, and the dose-area product (58.6 ± 64.0 vs. 233.5 ± 225.0 Gy*cm2, P < 0.001) was smaller in the NBCA group than in the PVA group. The median haemoptysis-free survival was 173.0 in the NBCA group compared with 20.0 days in the PVA group (P < 0.001). The PVA use (P < 0.001) and coagulopathy (P = 0.014) were independent predictors of shortened haemoptysis-free survival. CONCLUSION BAE using NBCA showed significantly superior initial hemostasis with longer haemoptysis-free survival, shorter procedure time, and reduced radiation dose than BAE using PVA particles. The PVA use and coagulopathy were independent predictors of recurrent haemoptysis. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Jae Hwan Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.,Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea. .,Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Yun Su Jung
- Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Won Seok Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.,Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Chong-Ho Lee
- Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Guy Mok Lee
- Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
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23
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Pulmonary Vascular Sequelae of Palliated Single Ventricle Circulation: Arteriovenous Malformations and Aortopulmonary Collaterals. J Cardiovasc Dev Dis 2022; 9:jcdd9090309. [PMID: 36135454 PMCID: PMC9501802 DOI: 10.3390/jcdd9090309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Children and adults with single ventricle congenital heart disease (CHD) develop many sequelae during staged surgical palliation. Universal pulmonary vascular sequelae in this patient population include two inter-related but distinct complications: pulmonary arteriovenous malformations (PAVMs) and aortopulmonary collaterals (APCs). This review highlights what is known and unknown about these vascular sequelae focusing on diagnostic testing, pathophysiology, and areas in need of further research.
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24
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Association between High Blood Pressure in the Emergency Department and Cryptogenic Hemoptysis. J Clin Med 2022; 11:jcm11185302. [PMID: 36142950 PMCID: PMC9504639 DOI: 10.3390/jcm11185302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Abstract
Hemoptysis is a common cause of emergency department (ED) visits. There is little data about the role of systemic hypertension as a cause of hemoptysis. The aim of this study was to evaluate the association between systemic blood pressure and the unknown etiology of hemoptysis. This retrospective study included consecutive patients who visited the ED owing to hemoptysis and underwent a chest computed tomography between January 2011 and June 2021. Details of the initial blood pressure at the ED visit were compared between two groups with identified and unidentified causes of hemoptysis. In total, 1105 adult patients were included. The etiology of hemoptysis was identified in 1042 patients (94.3%) and remained unidentified in 63 patients (5.7%). The percentage of patients with severe hypertension was significantly higher in patients with unidentified causes of hemoptysis than in those with identified causes (35% vs. 11%, p < 0.001). In multivariate analysis, age, ever-smoker, and initial systolic blood pressure were significantly associated with hemoptysis of unidentified causes. Although further studies are needed, our findings suggest a possible association between high blood pressure and cryptogenic hemoptysis.
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25
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Hümmler N, Elze M. Management von Hämoptysen: eine interdisziplinäre Herausforderung. Zentralbl Chir 2022; 147:S33-S46. [PMID: 36099935 DOI: 10.1055/a-1809-1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Nicolas Hümmler
- Klinik für Thoraxchirurgie, Department Chirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Mirjam Elze
- Klinik für Thoraxchirurgie, Department Chirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
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26
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Lee GM, Carroll MB, Galvin JR, Walker CM. Mosaic Attenuation Pattern. Radiol Clin North Am 2022; 60:963-978. [DOI: 10.1016/j.rcl.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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27
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Iguchi T, Mizuguchi S, Kyukwang C, Nakajima R, Takahama M. Desquamation of the subpleural lung parenchyma caused by empyema after pulmonary embolism: A case report. Respirol Case Rep 2022; 10:e01008. [PMID: 35865868 PMCID: PMC9289527 DOI: 10.1002/rcr2.1008] [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: 06/20/2022] [Accepted: 07/02/2022] [Indexed: 11/21/2022] Open
Abstract
Subpleural peripheral lung regions are mainly nourished by pulmonary arteries. Herein, we report a case in which pleural infection after pulmonary embolism caused circulation failure in the subpleural lung parenchyma (SLP) and massive desquamation of the SLP.
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Affiliation(s)
- Takafumi Iguchi
- Department of General Thoracic Surgery Osaka City General Hospital Osaka Japan
| | - Shinjiro Mizuguchi
- Department of General Thoracic Surgery Osaka City General Hospital Osaka Japan
| | - Chung Kyukwang
- Department of General Thoracic Surgery Osaka City General Hospital Osaka Japan
| | - Ryu Nakajima
- Department of General Thoracic Surgery Osaka City General Hospital Osaka Japan
| | - Makoto Takahama
- Department of General Thoracic Surgery Osaka City General Hospital Osaka Japan
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28
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[The bronchial arteries: a small but vital contribution to lung perfusion after lung transplantation]. Pneumologie 2022; 76:552-559. [PMID: 35878603 DOI: 10.1055/a-1845-0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Blood supply to the lungs is carried out by the pulmonary and bronchial-arterial system. The bronchial-arterial vessels are involved in supplying the small airways all the way up to the terminal bronchioles. The bronchial-arterial system is also necessary for the regulation of airway temperature, humidity and mucociliary clearance. Chronic ischaemia of the small airways due to damage or injury to bronchial arterial supply increases the risk of fibrosis of the small airways (bronchiolitis obliteration), especially in lung transplantation (LTx). Although survival after LTx has improved over time, it is, with a 5-year survival rate of only 50 to 60%, still significantly worse than that of other organ transplants. It is likely that bronchial arterial revascularisation at the time of LTx plays an important transplant-preserving function.
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29
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Gao Q, DeLaura IF, Anwar IJ, Kesseli SJ, Kahan R, Abraham N, Asokan A, Barbas AS, Hartwig MG. Gene Therapy: Will the Promise of Optimizing Lung Allografts Become Reality? Front Immunol 2022; 13:931524. [PMID: 35844566 PMCID: PMC9283701 DOI: 10.3389/fimmu.2022.931524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/09/2022] [Indexed: 01/21/2023] Open
Abstract
Lung transplantation is the definitive therapy for patients living with end-stage lung disease. Despite significant progress made in the field, graft survival remains the lowest of all solid organ transplants. Additionally, the lung has among the lowest of organ utilization rates-among eligible donors, only 22% of lungs from multi-organ donors were transplanted in 2019. Novel strategies are needed to rehabilitate marginal organs and improve graft survival. Gene therapy is one promising strategy in optimizing donor allografts. Over-expression or inhibition of specific genes can be achieved to target various pathways of graft injury, including ischemic-reperfusion injuries, humoral or cellular rejection, and chronic lung allograft dysfunction. Experiments in animal models have historically utilized adenovirus-based vectors and the majority of literature in lung transplantation has focused on overexpression of IL-10. Although several strategies were shown to prevent rejection and prolong graft survival in preclinical models, none have led to clinical translation. The past decade has seen a renaissance in the field of gene therapy and two AAV-based in vivo gene therapies are now FDA-approved for clinical use. Concurrently, normothermic ex vivo machine perfusion technology has emerged as an alternative to traditional static cold storage. This preservation method keeps organs physiologically active during storage and thus potentially offers a platform for gene therapy. This review will explore the advantages and disadvantages of various gene therapy modalities, review various candidate genes implicated in various stages of allograft injury and summarize the recent efforts in optimizing donor lungs using gene therapy.
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Affiliation(s)
- Qimeng Gao
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Isabel F. DeLaura
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Imran J. Anwar
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Samuel J. Kesseli
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Riley Kahan
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Nader Abraham
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Aravind Asokan
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
- Department of Molecular Genetics & Microbiology, Duke University School of Medicine, Durham, NC, United States
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Andrew S. Barbas
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Matthew G. Hartwig
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, United States
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30
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Chen Y, Lin L, Deng Q, Li N, Wang Z, Liu J, Sun H. Coronary artery-bronchial artery fistula imaging characteristics and its correlation with pulmonary disease severity. Heart Vessels 2022; 37:2101-2106. [PMID: 35729428 DOI: 10.1007/s00380-022-02106-y] [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: 12/20/2021] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Abstract
Hemoptysis is a common clinical emergency, bronchial arterial embolization is considered to be an effective treatment. The presence of coronary artery-bronchial artery fistula (CBF) may lead to recurrence of hemoptysis after treatment. It is necessary to investigate the imaging characteristics of a CBF and its correlation with the severity of pulmonary disease. With the development of multi-detector computed tomography, our study used the 320-slice CT bronchial artery angiography technology to observe and visualize blood vessels. The image and clinical data of 2015 hemoptysis patients with 320-slice CT bronchial artery angiography were retrospectively reviewed from January 2015 to December 2019. The axial and three-dimensional CT images were analyzed. The incidence, anatomical characteristics of CBF and pulmonary disease severity score were evaluated. A total of 12 CBF vessels were detected in 11 patients. We found that the incidence of CBF in this group was 0.55% (11/2015). Mean CBF diameter was 1.9 mm (1.2-2.5 mm). The course of CBF usually was relatively fixed. The proportions of CBF originated from the left circumflex artery, right coronary artery, and left anterior descending artery were 75%, 16.7% and 8.3%, respectively. Preliminarily analysis of the correlation between the trend of CBF and the pulmonary diseases severity score showed that CBF was more likely to communicate with a bronchial artery on the side with a higher severity score. CBF may occur in patients with chronic pulmonary disease and hemoptysis, and its origin, course and trend are characteristic. Detailed and comprehensive computed tomography angiography image analysis is helpful to improve the clinical treatment of hemoptysis with CBF.
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Affiliation(s)
- Yonghua Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Liaoyi Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Qingshan Deng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Na Li
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Zhenzhang Wang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Jinjin Liu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
| | - Houzhang Sun
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
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31
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García Jurado PB, Pérez Montilla ME, Lombardo Galera MS, Entrenas Castillo M, García-Revillo J, Espejo Herrero JJ. Embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate in patients with hemoptysis: A retrospective single-center study. RADIOLOGIA 2022; 65:99-105. [PMID: 37059585 DOI: 10.1016/j.rxeng.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate (NBCA) in patients with hemoptysis. METHODS We analyzed a total of 55 consecutive patients with hemoptysis (14 mild, 31 moderate, and 10 massive) treated with the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate between November 2013 and January 2020. The main variables analyzed were the rates of technical success, of clinical success, of recurrence, and of complications. Statistics included a descriptive analysis and Kaplan-Meier survival curves. RESULTS Embolization was a technical success in 55 (100%) and a clinical success in 54 (98.2%). During follow-up (mean, 23.8 months; interquartile range, 9.7-38.2 months), hemoptysis recurred in 5 (9.3%) patients. The nonrecurrence rate was 91.9% one year after the initial procedure and 88.7% two years and four years after the initial procedure. Minor complications related with the procedure occurred in 6 (10.9%); no major complications occurred. CONCLUSIONS The embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate is safe and efficacious for controlling hemoptysis, resulting in low recurrence rates.
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Affiliation(s)
- P B García Jurado
- Unidad de Gestión Clínica de Radiodiagnóstico y Cáncer de Mama, Sección de Radiología Vascular Intervencionista, Hospital Universitario Reina Sofía, Córdoba, Spain.
| | - M E Pérez Montilla
- Unidad de Gestión Clínica de Radiodiagnóstico y Cáncer de Mama, Sección de Radiología Vascular Intervencionista, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - M S Lombardo Galera
- Unidad de Gestión Clínica de Radiodiagnóstico y Cáncer de Mama, Sección de Radiología Vascular Intervencionista, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - M Entrenas Castillo
- Unidad de Gestión Clínica de Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J García-Revillo
- Unidad de Gestión Clínica de Radiodiagnóstico y Cáncer de Mama, Sección de Radiología Vascular Intervencionista, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J J Espejo Herrero
- Unidad de Gestión Clínica de Radiodiagnóstico y Cáncer de Mama, Sección de Radiología Vascular Intervencionista, Hospital Universitario Reina Sofía, Córdoba, Spain
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32
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CÈ M, Bombaci F, SDAO S, Marziali S, Irmici G, Boemi S, Cervelli M, Cellina M. A rare case of unilateral vocal cord paralysis: neurovascular conflict due to an aberrant bronchial artery detected at computed tomography. Radiol Case Rep 2022; 17:2052-2057. [PMID: 35450144 PMCID: PMC9018124 DOI: 10.1016/j.radcr.2022.03.033] [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: 12/29/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
We report the case of a 29-year-old patient without medical history presenting with dysphonia associated with left unilateral vocal cord paralysis. The patient underwent a contrast-enhanced computed tomography with an angiographic arterial phase of the head, neck and chest, and the only significant finding was the presence of a large, aberrant right bronchial artery originating directly from the aortic arch, where the recurrent left laryngeal nerve loops. After excluding alternative etiologies, the hypothesis of neurovascular conflict between this vessel and the recurrent left laryngeal nerve was formulated. To the best of our knowledge, this is the first case reported in the literature. Thanks to its high spatial resolution, contrast-enhanced computed tomography is the examination of choice for the study of anatomical variants and should be included in the routine work-up of patients presenting with unilateral vocal cord paralysis.
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Affiliation(s)
- Maurizio CÈ
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
- Corresponding author.
| | - Francesco Bombaci
- Radiology Department, ASST Fatebenefratelli Sacco, piazza Principessa Clotilde 3, 20121, Milan, Italy
| | - Silvana SDAO
- Radiology Department, ASST Fatebenefratelli Sacco, piazza Principessa Clotilde 3, 20121, Milan, Italy
| | - Sara Marziali
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Giovanni Irmici
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Sara Boemi
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Marco Cervelli
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Michaela Cellina
- Radiology Department, ASST Fatebenefratelli Sacco, piazza Principessa Clotilde 3, 20121, Milan, Italy
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33
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Abstract
Massive hemoptysis is a highly morbid medical condition with up to 75% mortality with conservative treatment. Bronchial artery embolization has emerged as the common treatment for both acute massive hemoptysis and chronic hemoptysis. This article will review the clinical presentation, bronchial artery anatomy, embolization procedure, complications, and expected outcomes.
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Affiliation(s)
- Claire S. Kaufman
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
| | - Sharon W. Kwan
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
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Meaney JFM, O'Donnell JS, Bridgewood C, Harbison J, McGonagle D. Perspective: The Case for Acute Large Vessel Ischemic Stroke in COVID-19 Originating Within Thrombosed Pulmonary Venules. Stroke 2022; 53:2411-2419. [PMID: 35543127 PMCID: PMC9232249 DOI: 10.1161/strokeaha.121.038056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The main burden of SARS-CoV-2 falls on the lungs but neurological manifestations, the most disabling of which are strokes and which correlate with disease severity, are common. We proffer a novel mechanism for acute COVID-19 stroke whereby pulmonary vein clots developing within the characteristic pulmonary intravascular thrombotic lesions can embolize to the brain. Appreciation of this mechanism requires an understanding of the tricompartmental model of lung parenchyma oxygenation (the alveolus, the bronchial artery, and the pulmonary artery), all of which are compromised in COVID-19. Of these 3 sources, the bronchial artery plays a crucial role in COVID-19 stroke because the unique collaterals from bronchial artery to pulmonary vein which exist under normal physiological conditions (and which maintain venous patency when the pulmonary artery is blocked by embolus) are occluded, thus leading to venular thrombosis in the presence of hypercoagulability. Dislodgement of clots from this source translocates the pathology to the brain and is a disease mechanism, formerly rare, which may account for many cases of large vessel occlusion stroke in COVID-19. This mechanism extends the concept of cardioembolic stroke from endocardium retrogradely into the pulmonary circulation with which the left cardiac chambers lie in direct continuity, and which is an accepted stroke mechanism under other circumstances such as lung lobectomy, where surgical ligation of the pulmonary vein creates a blind sac from which thrombi can embolize. The proposed model is supported by postmortem studies which have demonstrated venular thrombosis and by case reports of pulmonary vein thrombosis in COVID-19. This concept provides a more plausible cause for COVID-19 associated large vessel occlusion stroke than other putative mechanisms, such as cerebral endotheliitis, cytokine storm, and hypercoagulopathy, although it is acknowledged that the latter mechanism contributes to the genesis of pulmonary vein clots. Recognizing that extrapulmonary manifestations including stroke arise within thrombosed pulmonary veins is key to understanding of neurological manifestations of SARS-CoV-2 infection.
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Affiliation(s)
- James F M Meaney
- The Thomas Mitchell Centre for Advanced Medical Imaging, St James's Hospital, Trinity College Dublin, Ireland. (J.F.M.M.)
| | - James S O'Donnell
- Irish Centre for Vascular Biology, Royal College of Surgeons of Ireland (J.S.O.)
| | - Charles Bridgewood
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, United Kingdom (C.B.)
| | - Joseph Harbison
- Department of Stroke Medicine, Trinity College Dublin, Ireland. (J.H.)
| | - Dennis McGonagle
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, United Kingdom (D.M.)
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Ossaba Vélez S, Díez Tascón A, Parra Gordo M. El informe radiológico en la enfermedad vascular torácica urgente. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abe S, Kamikubo Y, Kato N, Kato H, Ooka T, Shingu Y, Wakasa S. Bronchial artery hypertrophy-associated perioperative pulmonary hemorrhage in cardiovascular surgery: a case report. Surg Case Rep 2022; 8:80. [PMID: 35486259 PMCID: PMC9054967 DOI: 10.1186/s40792-022-01432-7] [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: 01/27/2022] [Accepted: 04/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary hemorrhage is a life-threatening complication of cardiovascular surgery. Bronchial artery hypertrophy, a rare pathology associated with inflammatory and ischemic respiratory diseases, increases the risk of pulmonary hemorrhage; however, its involvement in cardiovascular surgery is not well known. We present two cardiovascular surgical cases in which embolization of the hypertrophied bronchial artery was effective in controlling perioperative pulmonary hemorrhage. Case presentation The first case was a 51-year-old man with chronic obstructive pulmonary disease who developed acute type A aortic dissection. After emergent surgery, his blood pressure suddenly dropped in the intensive care unit; computed tomography revealed a right hemothorax. Because a 4-mm dilated bronchial artery was identified on preoperative computed tomography, the hemothorax was suspected to be associated with bronchial artery hypertrophy. Selective bronchial arteriography was emergently performed and revealed a right pulmonary parenchymal blush. After subsequent coil embolization of the bronchial artery, the parenchymal blush disappeared, and his hemodynamic condition stabilized. The second case was a 66-year-old man with bronchiectasis who was referred for redo aortic valve replacement due to structural valve deterioration. A bioprosthesis was previously implanted to avoid permanent anticoagulation because the patient had repeated episodes of hemoptysis; however, he still had persistent hemosputum during admission for the redo aortic valve replacement. A dilated bronchial artery 3.7 mm in size was incidentally identified on preoperative computed tomography, and hence, the repeated hemosputum was suspected to be associated with bronchial artery hypertrophy. Bronchial arteriography revealed a right pulmonary parenchymal blush, and prophylactic embolization of the bronchial artery was performed. The hemosputum disappeared after the procedure, and redo aortic valve replacement was performed uneventfully 8 days later. Conclusion In cardiovascular surgery, the risk of pulmonary hemorrhage associated with bronchial artery hypertrophy should be considered, especially in patients with inflammatory and ischemic respiratory diseases.
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Affiliation(s)
- Shinji Abe
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kitaku, Sapporo, 060-8638, Japan
| | - Yasuhiro Kamikubo
- Department of Cardiovascular Surgery, Kushiro-City General Hospital, Kushiro, Japan
| | - Nobuyasu Kato
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kitaku, Sapporo, 060-8638, Japan
| | - Hiroki Kato
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kitaku, Sapporo, 060-8638, Japan
| | - Tomonori Ooka
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kitaku, Sapporo, 060-8638, Japan
| | - Yasushige Shingu
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kitaku, Sapporo, 060-8638, Japan
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kitaku, Sapporo, 060-8638, Japan.
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Yan HT, Lu GD, Huang XZ, Zhang DZ, Ge KY, Zhang JX, Liu J, Liu S, Shi HB, Zu QQ. Development of a model to predict recurrence after bronchial artery embolization for non-cancer related hemoptysis. BMC Pulm Med 2021; 21:419. [PMID: 34922497 PMCID: PMC8684203 DOI: 10.1186/s12890-021-01790-2] [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: 07/14/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Relapse after effective bronchial arterial embolization (BAE) for controlling hemoptysis is not uncommon. Studies reported diverse predictors of recurrence. However, a model to assess the probability of recurrence in non-cancer related hemoptysis patients after BAE has not been reported. This study was to develop a model to predict recurrence after BAE for non-cancer related hemoptysis. Methods The study cohort included 487 patients who underwent BAE for non-cancer-related hemoptysis between January 2015 and December 2019. We derived the model’s variables from univariate and multivariate Cox regression analyses. The model presented as a nomogram scaled by the proportional regression coefficient of each predictor. Model performance was assessed with respect to discrimination and calibration. Results One-month and 1-, 2-, 3- and 5-year recurrence-free rates were 94.5%, 88.0%, 81.4%, 76.2% and 73.8%, respectively. Risk factors for recurrence were underlying lung diseases and the presence of systemic arterial-pulmonary circulation shunts. This risk prediction model with two risk factors provided good discrimination (area under curve, 0.69; 95% confidence interval, 0.62–0.76), and lower prediction error (integrated Brier score, 0.143). Conclusion The proposed model based on routinely available clinical and imaging features demonstrates good performance for predicting recurrence of non-cancer-related hemoptysis after BAE. The model may assist clinicians in identifying higher-risk patients to improve the long-term efficacy of BAE.
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Affiliation(s)
- Hai-Tao Yan
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Guang-Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiang-Zhong Huang
- Department of Interventional Radiology, Jiangyin People's Hospital, Wuxi, 214400, China
| | - Da-Zhong Zhang
- Department of Interventional Radiology, Jiangsu Taizhou People's Hospital, Taizhou, 225300, China
| | - Kun-Yuan Ge
- Department of Interventional Radiology, Yixing People's Hospital, Wuxi, 214200, China
| | - Jin-Xing Zhang
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Jin Liu
- Department of Clinical Medicine Research Institution, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Qing-Quan Zu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
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Omachi N, Ishikawa H, Nishihara T, Yamaguchi Y, Kitaoka A, Kitaguchi K, Hattori T, Kawaguchi T. Bronchial artery aneurysm: Prevalence, clinical characteristics, and long-term prognosis following bronchial artery embolization. J Vasc Interv Radiol 2021; 33:121-129. [PMID: 34752932 DOI: 10.1016/j.jvir.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To investigate the prevalence, clinical characteristics, and long-term prognosis of bronchial artery aneurysm (BAA) following bronchial artery embolization (BAE). MATERIALS AND METHODS The medical records of consecutive patients who underwent bronchial artery angiography between August 2013 to December 2019 were reviewed retrospectively. Patients who were diagnosed with BAA during this period were enrolled in this study. The prevalence, patients' characteristics, symptoms, comorbidities, angiographic findings, and long-term prognosis following BAE were investigated. RESULTS BAA was observed in 20 out of 508 patients who underwent bronchial artery angiography (3.9%). The patients' median age was 69 years (range 44-91). The main causes of BAA were cryptogenic, bronchiectasis/cystic fibrosis, and pulmonary aspergillosis. The median diameter of the ruptured BAAs was significantly smaller than that of the unruptured BAAs [5.4 mm (4.8-7.3 mm) versus 9.0 mm (7.2-13.9 mm), p = 0.009]. All patients were successfully treated with BAE without major adverse events. The median follow-up period after BAE was 970 (quartiles: 561-1796) days. The BAA-related survival rate was 100% at 2 and 3 years after BAE, and the overall survival rate after BAE was 89.2% (95% CI: 89.0-89.3) at 2 years and 74.3% (95% CI, 74.0-74.5) at 3 years. BAA related adverse events and mortality did not occur during the follow up period. CONCLUSION BAA was observed in 3.9 % (20/508) of patients who underwent bronchial artery angiography. All patients with BAA were successfully treated by BAE. BAA rupture and consequent mortality did not occur during follow up period.
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Affiliation(s)
- Naoki Omachi
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
| | - Hideo Ishikawa
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Takashi Nishihara
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yu Yamaguchi
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Aya Kitaoka
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazushi Kitaguchi
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomoaki Hattori
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomoya Kawaguchi
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Crespo MM. Airway complications in lung transplantation. J Thorac Dis 2021; 13:6717-6724. [PMID: 34992847 PMCID: PMC8662498 DOI: 10.21037/jtd-20-2696] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/13/2021] [Indexed: 12/03/2022]
Abstract
Airway complications (ACs) after lung transplantation remain an important source of morbidity and mortality despite significant advances in the surgical technics, leading to increased cost, and decrease quality of life. The incidences of ACs after lung transplantation range from 2% to 33%, even though most transplant centers have reported rates in the range of 7% to 8%. However, the reported rate of ACs has been inconsistent as a result of a lack of standardized airway definitions and grading protocols before the recent 2018 International Society for Heart and Lung Transplantation (ISHLT) proposed consensus guidelines on ACs after lung transplantation. The ACs include stenosis, perioperative and postoperative bronchial infections, bronchial necrosis and dehiscence, excess granulation tissue, and tracheobronchomalacia (TBM). Anastomosis infection, necrosis, or dehiscence typically develops within the first month after lung transplantation. The most frequent AC after lung transplantation is bronchial stenosis. Several risk factors have been proposed to the development of ACs after lung transplantation, including surgical anastomosis techniques, hypoperfusion, infections, donor and recipient factors, immunosuppression agents, and organ preservation. ACs might be prevented by early recognition of the airway pathology, using advance medical management, and interventional bronchoscopy procedures. Balloon bronchoplasty, cryotherapy, laser photo resection, electrocautery, high-dose endobronchial brachytherapy, and bronchial stents placement are the most frequent interventional bronchoscopic procedures utilized for the management of ACs.
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Affiliation(s)
- Maria M Crespo
- Pulmonary, Allergy and Critical Care Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Imaging of congenital lung diseases presenting in the adulthood: a pictorial review. Insights Imaging 2021; 12:153. [PMID: 34716817 PMCID: PMC8557233 DOI: 10.1186/s13244-021-01095-2] [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: 07/22/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022] Open
Abstract
Congenital lung diseases in adults are rare diseases that can present with symptoms or be detected incidentally. Familiarity with the imaging features of different types of congenital lung diseases helps both in correct diagnosis and management of these diseases. Congenital lung diseases in adults are classified into three main categories as bronchopulmonary anomalies, vascular anomalies, and combined bronchopulmonary and vascular anomalies. Contrast-enhanced computed tomography, especially 3D reconstructions, CT, or MR angiography, can show vascular anomalies in detail. The tracheobronchial tree, parenchymal changes, and possible complications can also be defined on chest CT, and new applications such as quantitative 3D reconstruction CT images, dual-energy CT (DECT) can be helpful in imaging parenchymal changes. In addition to the morphological assessment of the lungs, novel MRI techniques such as ultra-short echo time (UTE), arterial spin labeling (ASL), and phase-resolved functional lung (PREFUL) can provide functional information. This pictorial review aims to comprehensively define the radiological characteristics of each congenital lung disease in adults and to highlight differential diagnoses and possible complications of these diseases.
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Derenoncourt PR, Felder GJ, Royal HD, Bhalla S, Lang JA, Matesan MC, Itani M. Ventilation-Perfusion Scan: A Primer for Practicing Radiologists. Radiographics 2021; 41:2047-2070. [PMID: 34678101 DOI: 10.1148/rg.2021210060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lung scintigraphy, or ventilation-perfusion (V/Q) scan, is one of the commonly performed studies in nuclear medicine. Owing to variability in clinical applications and different departmental workflows, many trainees are not comfortable interpreting the results of this study. This article provides a simplified overview of V/Q imaging, including a review of its technique, interpretation methods, and established and emerging clinical applications. The authors review the role of V/Q imaging in evaluation of acute and chronic pulmonary embolism, including the role of SPECT/CT and comparing V/Q scan with CT angiography. In addition, a variety of other applications of pulmonary scintigraphy are discussed, including congenital heart disease, pretreatment planning for lung cancer and emphysema, posttransplant imaging for bronchiolitis obliterans, and less common vascular and nonvascular pathologic conditions that may be detected with V/Q scan. This article will help radiologists and residents interpret the results of V/Q scans and understand the various potential clinical applications of this study. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Paul-Robert Derenoncourt
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Gabriel J Felder
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Henry D Royal
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Jordan A Lang
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Manuela C Matesan
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
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Emad Y, Ragab Y, Robinson C, Pankl S, Young P, Fabi M, Bawaskar P, Ibrahim O, Erkan D, Barman B, Tekavec-Trkanjec J, Jayakrishnan B, Kindermann M, Kechida M, Guffroy A, Silva RS, Frikha F, Abou-Zeid A, Hassan M, Farber HW, Abdelbary MH, Tornes L, Margolesky J, El-Shaarawy N, Bennji S, Agarwala MK, Saad A, Amezyane T, Ghirardo S, Cruz V, Niemeyer B, Al-Zeedy K, Al-Jahdali H, Jaramillo N, Demirkan S, Kably I, Kim JT, Rasker JJ. Pulmonary vasculitis in Hughes-Stovin syndrome (HSS): a reference atlas and computed tomography pulmonary angiography guide-a report by the HSS International Study Group. Clin Rheumatol 2021; 40:4993-5008. [PMID: 34533671 PMCID: PMC8599253 DOI: 10.1007/s10067-021-05912-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/11/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022]
Abstract
Introduction Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by widespread venous/arterial thrombosis and pulmonary artery aneurysms (PAAs), which is associated with serious morbidity and mortality. All fatalities reported in HSS resulted from unpredictable fatal suffocating hemoptysis. Therefore, it is necessary to recognize pulmonary complications at an early stage of the disease. Objectives The aims of this study are to develop a reference atlas of images depicting the characteristic features of HSS by computed tomography pulmonary angiography (CTPA). To make a guide for physicians by developing a classification of PAAs according to the severity and risk of complications associated with each distinct lesion type. Methods The Members of the HSS International Study Group (HSSISG) collected 42 cases, with high-quality CTPA images in one radiology station and made reconstructions from the source images. These detailed CTPA studies were reviewed for final image selection and approved by HSSISG board members. We classified these findings according to the clinical course of the patients. Results This atlas describes the CTPA images that best define the wide spectrum of pulmonary vasculitis observed in HSS. Pulmonary aneurysms were classified into six radiographic patterns: from true stable PAA with adherent in-situ thrombosis to unstable leaking PAA, BAA and/or PAP with loss of aneurysmal wall definition (most prone to rupture), also CTPA images demonstrating right ventricular strain and intracardiac thrombosis. Conclusion The HSSISG reference atlas is a guide for physicians regarding the CTPA radiological findings, essential for early diagnosis and management of HSS-related pulmonary vasculitis.
Key Points • The Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by extensive vascular thrombosis and pulmonary artery aneurysms (PAAs) that can lead to significant morbidity and mortality. • All fatalities reported in HSS were related to unpredictable massive hemoptysis; therefore, it is critical to recognize pulmonary complications at an early stage of the disease. • The HSS International Study Group reference atlas classifies pulmonary vasculitis in HSS at 6 different stages of the disease process and defines the different radiological patterns of pulmonary vasculitis notably pulmonary artery aneurysms, as detected by computed tomography pulmonary angiography (CTPA). • The main aim of the classification is to make a guide for physicians about this rare syndrome. Such a scheme has never been reached before since the first description of the syndrome by Hughes and Stovin since 1959. This classification will form the basis for future recommendations regarding diagnosis and treatment of this syndrome. |
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St., Cairo, 11562, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St., Cairo, 11562, Egypt
| | - Cal Robinson
- Department of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sonia Pankl
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Pablo Young
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Marianna Fabi
- Pediatric Cardiology and Adult Congenital Unit, S. Orsola-Malpighi Hospital, University of Bologna, 40138, Bologna, Italy
| | - Parag Bawaskar
- Department of Cardiology, Topiwala National Medical College & B.Y.L Nair Charitable Hospital, Dr. A.L. Nair Road, Mumbai, 400008, Maharashtra, India
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Ashton Rd., LancashireLancaster, LA1 4RP, UK
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Bhupen Barman
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Mawdiangdiang, Shillong, 793018, Meghalaya, India
| | - Jasna Tekavec-Trkanjec
- Department of Pulmonary Medicine, Dubrava University Hospital, AvenijaGojkaŠuška 6, 10000, Zagreb, Croatia
| | | | - Michael Kindermann
- Innere Medizin III (Kardiologie/Angiologie), Universitätskliniken Des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Germany
| | - Melek Kechida
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, University of Monastir, Rue du 1er juin 1955, 5019, Monastir, Tunisia
| | - Aurelien Guffroy
- Service D'immunologieclinique et Médecine Interne, Centre de Référence des Maladies Auto-Immunes Systémiquesrares (RESO), hôpitauxuniversitaires de Strasbourg, nouvelhôpital civil, 67091, Strasbourg, France.,UFR Médecine Strasbourg, Université de Strasbourg, 67000, Strasbourg, France
| | - Rafael S Silva
- Unidad de Enfermedades Respiratorias, Hospital Regional de Talca, Calle 1 Norte 1990, Talca, Chile
| | - Faten Frikha
- Department of Internal Medicine, HediChaker Hospital, 3029, Sfax, Tunisia
| | - Alaa Abou-Zeid
- Public Health Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St., Cairo, 11562, Egypt
| | - Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University - Al Kartoom Square, Al Azareta, Alexandria, 21526, Egypt
| | - Harrison W Farber
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Mohamed H Abdelbary
- Department of Radiology, Badr Hospital, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Leticia Tornes
- Department of Neurology, University of Miami Miller School of Medicine, Professional Arts Center, 1150 NW 14th St., Suite 609, Miami, FL, 33136, USA
| | - Jason Margolesky
- Department of Neurology, University of Miami Miller School of Medicine, Professional Arts Center, 1150 NW 14th St., Suite 609, Miami, FL, 33136, USA
| | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia 4.5 Km the Ring Road, Ismailia, 41522, Egypt
| | - Sami Bennji
- Division of Pulmonology, Department of Medicine, Tygerberg Academic Hospital/Stellenbosch University, Francie van Zijl Drive Tygerberg 7505, Cape Town, South Africa
| | - Manoj Kumar Agarwala
- Department of Cardiology, Apollo Hospitals, Jubilee Hills, Hyderabad, 500096, India
| | - Ahmed Saad
- Internal Medicine Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St., Cairo, 11562, Egypt
| | - Taoufik Amezyane
- Department of Internal Medicine, School of Medicine, Mohammed V Military Teaching Hospital, Mohammed V-Souissi University, Rabat, Morocco
| | - Sergio Ghirardo
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Piazzale Europa, 1, 34127, Trieste, TS, Italy
| | - Vitor Cruz
- Serviço de Reumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Bruno Niemeyer
- Departamento de Radiologia, Instituto Estadual do Cérebro Paulo Niemeyer, R. do Rezende, 156 - Centro, Rio de Janeiro, RJ, 20231-092, Brazil
| | - Khalfan Al-Zeedy
- Department of Medicine, Sultan Qaboos University Hospital, 123, Al-Khoud, Muscat, Oman
| | - Hamdan Al-Jahdali
- Pulmonary Division, Department of Medicine, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh, 11426, Saudi Arabia
| | - Natalia Jaramillo
- Cardiology Department, Hospital Puerta de HierroMajadahonda, C/Joaquin Rodrigo 3, 28222, Madrid, Spain
| | - Serkan Demirkan
- Department of Dermatology and Venerology, Faculty of Medicine, Izmir KatipÇelebi University, Karabağlar, Izmir, Turkey
| | - Issam Kably
- Department of Radiology, Section of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jung Tae Kim
- Department of Cardiovascular and Thoracic Surgery, Cheonan Chungmu Hospital, 8 Dagamal 3-gil Seobuk-gu, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Johannes J Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Drienerlolaan 5, 7522NB, Enschede, The Netherlands
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Charya AV, Holden VK, Pickering EM. Management of life-threatening hemoptysis in the ICU. J Thorac Dis 2021; 13:5139-5158. [PMID: 34527355 PMCID: PMC8411133 DOI: 10.21037/jtd-19-3991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022]
Abstract
Life-threatening hemoptysis is commonly encountered in the ICU and its management can be challenging even for experienced clinicians. Depending on the etiology and severity, one can tailor the treatment modality and therapeutic intervention(s). The grading of severity of hemoptysis varies greatly in the literature; however, unlike hemorrhage in other scenarios, small amounts of blood can significantly impair oxygenation and ventilation leading to cardiovascular collapse. Importantly, the initial evaluation and management should focus on airway and hemodynamic stabilization along with maintenance of oxygenation and ventilation. In this review, we discuss commonly encountered etiologies, vascular anatomy, diagnostic evaluation, and therapeutic interventions. We examine the evolving trends in etiologies of life-threating hemoptysis over the years. The role of flexible and rigid bronchoscopy as both a diagnostic and therapeutic modality is explored, as well as the use and indications of several bronchoscopic techniques, such as topical hemostatic agents, endobronchial tamponade, and tranexamic acid (TXA). In addition, we assess the use of multi-row detector computed tomography as the initial rapid diagnostic method of choice and its use in planning for definitive treatment. The efficacy and long-term results of bronchial artery embolization (BAE) are evaluated, as well as indications for surgical intervention. Furthermore, the importance of a multidisciplinary approach is emphasized. The necessary interplay between intensivists, consultative services, and radiologists is described in detail and an algorithmic management strategy incorporating the above is outlined. Given the complexity in management of life-threatening hemoptysis, this paper aims to summarize the available diagnostic and therapeutic methods and provide a standardized approach for the management of patients with this often difficult to treat condition.
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Affiliation(s)
- Ananth V Charya
- Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Van K Holden
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edward M Pickering
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
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Rossi UG, Petrocelli F, Cariati M. Bronchial Artery Aneurysm and Pseudoaneurysm: Which Endovascular Treatment? Arch Bronconeumol 2021; 57:612-613. [PMID: 35698944 DOI: 10.1016/j.arbr.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/03/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Umberto G Rossi
- Department of Radiological Area - Interventional Radiology Unit, E.O. Galliera Hospital, Mura delle Cappuccine 14, 16128 Genova, Italy.
| | - Francesco Petrocelli
- Department of Radiology and Interventional Radiology, IRCCS San Martino Policlinic University Hospital, Largo Rosanna Benzi 10, 16132 Genova, Italy
| | - Maurizio Cariati
- Department of Diagnostic and Therapeutic Advanced Technology - Diagnostic and Interventional Radiology Unit, Azienda Socio Sanitaria Territoriale Santi Paolo and Carlo Hospital, Via A di Rudinì, 8 - Via Pio II, 3-20100 Milano, Italy
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Mediastinal anatomical landmarks, their variants and tips for video-assisted thoracoscopic navigation during oesophageal extirpation. Surg Radiol Anat 2021; 44:117-127. [PMID: 34426859 PMCID: PMC8758612 DOI: 10.1007/s00276-021-02820-8] [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: 04/25/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022]
Abstract
Purpose There is no systematic description of primary anatomical landmarks that allow a surgeon to reliably and safely navigate the superior and posterior mediastinum’s fat tissue spaces near large vessels and nerves during video-assisted endothoracoscopic interventions in the prone position of a patient. Our aim was to develop an algorithm of sequential visual navigation during thoracoscopic extirpation of the esophagus and determine the most permanent topographic and anatomical landmarks allowing safe thoracoscopic dissection of the esophagus in the prone position. Methods The anatomical study of the mediastinal structural features was carried out on 30 human cadavers before and after opening the right pleural cavity. Results For thoracoscopic extirpation of the esophagus in the prone position, anatomical landmarks are defined, their variants are assessed, and an algorithm for their selection is developed, allowing their direct visualization before and after opening the mediastinal pleura. Conclusion The proposed algorithm for topographic and anatomical navigation based on the key anatomical landmarks in the posterior mediastinum provides safe performance of the video-assisted thoracoscopic extirpation of the esophagus in the prone position.
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Levy J, Kashem A, Sunagawa G, Zhao H, Minakata K, Keshavamurthy S, Brann S, Leotta E, Shigemura N, Toyoda Y. POST-OPERATIVE BRONCHIAL COMPLICATIONS FOLLOWING LUNG TRANSPLANTATION RELATED TO ANASTOMOSIS SUTURE. Ann Thorac Surg 2021; 114:293-300. [PMID: 34358521 DOI: 10.1016/j.athoracsur.2021.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Post-operative bronchial anastomotic complications are not uncommon in lung transplant (LTx) recipients. We investigated two surgical techniques (continuous and interrupted sutures) during bronchial anastomosis, comparing survival and post-operative bronchial complications. METHODS We retrospectively analyzed 421 patients who were transplanted in our center (February-2012 to March-2018). Patients were divided according to bronchial anastomotic technique, continuous or interrupted. Demographics and clinical parameters were compared for significance (p<0.05). Comparison of post-operative morbidity included bronchial complications, Veno-Venous extracorporeal membrane oxygenation support and intervention requirements. Survival was assessed using Kaplan-Meier curve and log-rank tests (p<0.05). RESULTS Of the 421 patients, 290 underwent bronchial anastomoses with continuous suture; 44 patients had post-operative bronchial complications (15.2%). Contrarily, 131 patients underwent the interrupted suture technique; 9 patients had post-operative bronchial complications (6.9%). Demographics and clinical parameters included age, gender, ethnicity, etiology, lung allocation score, body mass index, donor age, LTx type, cardiopulmonary bypass usage, surgical approaches, and median length of stay. Post-operative complications (continuous vs. interrupted) were bronchial complications (p=0.017), Veno-venous extracorporeal membrane oxygenation support (p=0.41), Veno-arterial extracorporeal membrane oxygenation support (p=0.38), and complications requiring dilatation with stent placement (p=0.09). Kaplan-Meier curve showed better survival in the interrupted group (p=0.0002). CONCLUSIONS Our study demonstrated the comparable post-operative results between the continuous and interrupted technique.
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Affiliation(s)
- Jacob Levy
- Lankenau Medical Center, Division of General Surgery.
| | - Abul Kashem
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Gengo Sunagawa
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Huaqing Zhao
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Kenji Minakata
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | - Stacey Brann
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Eros Leotta
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Norihisa Shigemura
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Yoshiya Toyoda
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Hanidziar D, Robson SC. Synapomorphic features of hepatic and pulmonary vasculatures include comparable purinergic signaling responses in host defense and modulation of inflammation. Am J Physiol Gastrointest Liver Physiol 2021; 321:G200-G212. [PMID: 34105986 PMCID: PMC8410108 DOI: 10.1152/ajpgi.00406.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hepatosplanchnic and pulmonary vasculatures constitute synapomorphic, highly comparable networks integrated with the external environment. Given functionality related to obligatory requirements of "feeding and breathing," these organs are subject to constant environmental challenges entailing infectious risk, antigenic and xenobiotic exposures. Host responses to these stimuli need to be both protective and tightly regulated. These functions are facilitated by dualistic, high-low pressure blood supply of the liver and lungs, as well as tolerogenic characteristics of resident immune cells and signaling pathways. Dysregulation in hepatosplanchnic and pulmonary blood flow, immune responses, and microbiome implicate common pathogenic mechanisms across these vascular networks. Hepatosplanchnic diseases, such as cirrhosis and portal hypertension, often impact lungs and perturb pulmonary circulation and oxygenation. The reverse situation is also noted with lung disease resulting in hepatic dysfunction. Others, and we, have described common features of dysregulated cell signaling during liver and lung inflammation involving extracellular purines (e.g., ATP, ADP), either generated exogenously or endogenously. These metabokines serve as danger signals, when released by bacteria or during cellular stress and cause proinflammatory and prothrombotic signals in the gut/liver-lung vasculature. Dampening of these danger signals and organ protection largely depends upon activities of vascular and immune cell-expressed ectonucleotidases (CD39 and CD73), which convert ATP and ADP into anti-inflammatory adenosine. However, in many inflammatory disorders involving gut, liver, and lung, these protective mechanisms are compromised, causing perpetuation of tissue injury. We propose that interventions that specifically target aberrant purinergic signaling might prevent and/or ameliorate inflammatory disorders of the gut/liver and lung axis.
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Affiliation(s)
- Dusan Hanidziar
- 1Department of Anesthesia, Critical Care and Pain Medicine, grid.32224.35Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Simon C. Robson
- 2Department of Anesthesia, Critical Care and Pain Medicine, Center for Inflammation Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts,3Department of Medicine, Division of Gastroenterology/Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Ledda RE, Balbi M, Milone F, Ciuni A, Silva M, Sverzellati N, Milanese G. Imaging in non-cystic fibrosis bronchiectasis and current limitations. BJR Open 2021; 3:20210026. [PMID: 34381953 PMCID: PMC8328081 DOI: 10.1259/bjro.20210026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 01/21/2023] Open
Abstract
Non-cystic fibrosis bronchiectasis represents a heterogenous spectrum of disorders characterised by an abnormal and permanent dilatation of the bronchial tree associated with respiratory symptoms. To date, diagnosis relies on computed tomography (CT) evidence of dilated airways. Nevertheless, definite radiological criteria and standardised CT protocols are still to be defined. Although largely used, current radiological scoring systems have shown substantial drawbacks, mostly failing to correlate morphological abnormalities with clinical and prognostic data. In limited cases, bronchiectasis morphology and distribution, along with associated CT features, enable radiologists to confidently suggest an underlying cause. Quantitative imaging analyses have shown a potential to overcome the limitations of the current radiological criteria, but their application is still limited to a research setting. In the present review, we discuss the role of imaging and its current limitations in non-cystic fibrosis bronchiectasis. The potential of automatic quantitative approaches and artificial intelligence in such a context will be also mentioned.
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Affiliation(s)
- Roberta Eufrasia Ledda
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Maurizio Balbi
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Francesca Milone
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Andrea Ciuni
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Gianluca Milanese
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
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Yan HT, Lu GD, Huang XZ, Zhang DZ, Ge KY, Zhang JX, Liu J, Liu S, Zu QQ, Shi HB. A Nomogram to Predict Recurrence After Bronchial Artery Embolization for Hemoptysis Due to Bronchiectasis. Cardiovasc Intervent Radiol 2021; 44:1609-1617. [PMID: 34282490 DOI: 10.1007/s00270-021-02923-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop and validate a nomogram for predicting recurrent hemoptysis after successful bronchial arterial embolization (BAE) in patients with bronchiectasis. MATERIALS AND METHODS From January 2015 to December 2019, a total of 251 patients were enrolled in this study. A nomogram was developed with the predictors of recurrent events, which were identified by univariate and multivariate Cox regression analyses. We evaluated nomogram discrimination by area under the receiver operating characteristic curve, calibration by the calibration curve, and clinical usefulness potential by decision curve analysis. RESULTS The one-month, 1-year, 2-year, 3-year, and 5-year cumulative recurrence-free rates of patients were 98.4%, 90.5%, 82.8%, 77.7%, and 74.4%, respectively. Three predictive factors, namely sex, lung destruction, and systemic arterial-pulmonary circulation shunts, were applied to develop the nomogram. The model maintained good discrimination (area under the curve, 0.72; 95% confidence interval, 0.62-0.81), low prediction error (integrated Brier score, 0.129), and certain net benefits in terms of clinical usefulness. CONCLUSIONS The proposed nomogram showed favorable predictive efficacy for hemoptysis recurrence after BAE in patients with bronchiectasis. Improved long-term outcomes are expected with close follow-up, a healthy lifestyle, and pulmonary rehabilitation for patients at risk of recurrence according to the model.
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Affiliation(s)
- Hai-Tao Yan
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Guang-Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiang-Zhong Huang
- Department of Interventional Radiology, Jiangyin People's Hospital, Wuxi, 214400, China
| | - Da-Zhong Zhang
- Department of Interventional Radiology, Jiangsu Taizhou People's Hospital, Taizhou, 225300, China
| | - Kun-Yuan Ge
- Department of Interventional Radiology, Yixing People's Hospital, Wuxi, 214200, China
| | - Jin-Xing Zhang
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Jin Liu
- Department of Clinical Medicine Research Institution, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Qing-Quan Zu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
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Sun J, Li H, Gao J, Li J, Li M, Zhou Z, Peng Y. Performance evaluation of a deep learning image reconstruction (DLIR) algorithm in "double low" chest CTA in children: a feasibility study. Radiol Med 2021; 126:1181-1188. [PMID: 34132926 DOI: 10.1007/s11547-021-01384-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/08/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Chest CT angiography (CTA) is a convenient clinical examination for children with an increasing need to reduce both radiation and contrast medium doses. Iterative Reconstruction algorithms are often used to reduce image noise but encounter limitations under low radiation dose and conventional 100 kVp tube voltage may not provide adequate enhancement under low contrast dose. PURPOSE To evaluate the performance of a deep learning image reconstruction (DLIR) algorithm in conjunction with lower tube voltage in chest CTA in children under reduced radiation and contrast medium (CM) dose. MATERIALS AND METHODS 46 Children (age 5.9 ± 4.2 years) in the study group underwent chest CTA with 70 kVp and CM dose of 0.8-1.2 ml/kg. Images were reconstructed at 0.625 mm using a high setting DLIR (DLIR-H). The control group consisted of 46 age-matching children scanned with 100 kVp, CM dose of 1.3-1.8 ml/kg and images reconstructed with 50% and 100% adaptive statistical iterative reconstruction-V. Two radiologists evaluated images subjectively for overall image noise, vessel contrast and vessel margin clarity separately on a 5-point scale (5, excellent and 1, not acceptable). CT value and image noise of aorta and erector spinae muscle were measured. RESULTS Compared to the control group, the study group reduced the dose-length-product by 11.2% (p = 0.01) and CM dose by 24% (p < 0.001), improved the enhancement in aorta (416.5 ± 113.1HU vs. 342.0 ± 57.6HU, p < 0.001) and reduced noise (15.1 ± 3.5HU vs. 18.6 ± 4.4HU, p < 0.001). The DLIR-H images provided acceptable scores on all 3 aspects of the qualitative evaluation. CONCLUSION "Double low" chest CTA in children using 70 kVp and DLIR provides high image quality with reduced noise and improved vessel enhancement for diagnosis while further reduces radiation and CM dose.
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Affiliation(s)
- Jihang Sun
- Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Haoyan Li
- Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Jun Gao
- Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | | | | | - Zuofu Zhou
- Department of Radiology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fujian, 350000, China
| | - Yun Peng
- Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China.
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