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Chest: Pulmonary Arteries Beyond Pe Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Chest ❯ Pulmonary Arteries Beyond PE

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  • Shone Complex
    - Shone complex is a congenital heart defect consisting of four obstructive defects in the left heart: a mitral supravalvular ring, sub-aortic stenosis, parachute mitral valve, and coarctation of the aorta (CoA), which affects only a small minority of people.
  • Shone Complex
    - Its complete form associates a supra-mitral valve ring, sub aortic stenosis, parachute mitral valve (PMV), and coarctation of the aorta. Otherwise, the incomplete form, which is the most common, consists of a left ventricle inlet defect (PMV, Mitral stenosis congenitally or supravalvular mitral ring) associated with at least one left ventricular escape lesion (bicuspid aortic valve, subvalvular aortic stenosis, coarctation of the aorta)
  • The complete Shone syndrome consists of four cardinal left-sided cardiac defects
    - supravalvular mitral membrane
    - subvalvular aortic stenosis (membranous or muscular)
    - parachute mitral valve
    - coarctation of the aorta
    - Although four features were originally described, it is more common for patients to have incomplete Shone syndrome with only some of the obstructive lesions 
  • “Septic emboli are seen most commonly in patients with infective endocarditis, patients with infected venous catheters or pace-maker leads, and patients with periodontal disease.”

    High-Resolution MDCT of Pulmonary Septic Embolism: Evaluation of the Feeding Vessel Sign 
Dodd JD et al.
AJR 2006; 187:623–629
  • “Septic emboli are seen most commonly in patients with infective endocarditis, patients with infected venous catheters or pace-maker leads, and patients with periodontal disease.”

    High-Resolution MDCT of Pulmonary Septic Embolism: Evaluation of the Feeding Vessel Sign 
Dodd JD et al.
AJR 2006; 187:623–629
  • “The CT appearance of septic emboli includes nodules and wedge-shaped subpleural opacities with or without cavitation and the feeding vessel sign. The feeding vessel sign consists of a distinct vessel leading directly into the center of a nodule. This sign has been considered highly suggestive of septic embolism, the prevalence varying from 67–100% in various series.”


    High-Resolution MDCT of Pulmonary Septic Embolism: Evaluation of the Feeding Vessel Sign 
Dodd JD et al.
AJR 2006; 187:623–629
  • “Septic emboli are seen most commonly in patients with infective endocarditis, patients with infected venous catheters or pacemaker leads, and in patients with periodontal disease.”


    High-Resolution MDCT of Pulmonary Septic Embolism: Evaluation of the Feeding Vessel Sign 
Dodd JD et al.
AJR 2006; 187:623–629
  • “In conclusion, septic embolism is charac- terized by the presence of multiple nodules in various stages of cavitation and pleura-based wedge-shaped opacities. Although many of these nodules appear to have a central vessel on cross-sectional images, multiplanar reconstructions and MIP images show that in most cases these vessels course around the nodule. The “feeding vessel” seen in the other cases represents a pulmonary vein.”

    High-Resolution MDCT of Pulmonary Septic Embolism: Evaluation of the Feeding Vessel Sign 
Dodd JD et al.
AJR 2006; 187:623–629
  • “We conclude that SPE presents with variable and often nonspecific clinical and radiographic features. The diagnosis is usually suggested by the presence of a predisposing factor, febrile illness, and CT findings of multiple, nodular lung infiltrates peripherally, with or without cavitation.”


    Septic pulmonary embolism: presenting features and clinical course of 14 patients.
Cook RJ et al.
Chest. 2005 Jul;128(1):162-6.
  • "There is a moderately strong relationship between the size of the segmental pulmonary arteries and mean pulmonary arterial pressure (mPAP)"

    Detection of Pulmonary Hypertension with Multidetector CT and Echocardiography Alone and in Combination
    Devaraj A et al.
    Radiology 2010; 254:609-616

  • " Measuring pulmonary arterial size by using coronal oblique reformats to calculate the ratio of the cross sectional area of the main pulmonary artery to the diameter of the ascending aorta does not strengthen correlations with mPAP compared with the ratio of the simple axial diameter of the main pulmonary artery to the diameter of the ascending aorta."

    Detection of Pulmonary Hypertension with Multidetector CT and Echocardiography Alone and in Combination
    Devaraj A et al.
    Radiology 2010; 254:609-616

  • Bronchial Artery Aneurysm: Etiologies

    - Bronchiectasis
    - Mycotic origin
    - Osler Weber Rendu sydrome
  • "By providing thin section transaxial,multiplanar reconstruction, and 3D images, CT angiography using MDCT allows comparable or better images than conventional angiography with respect to the depiction of bronchial or nonbronchial systemic arteries."

    Bronchial and Nonbronchial Systemic Arteries in patients with Hemoptysis: Detection on MDCT Angiography
    Chung MJ et al.
    AJR 2006;186:649-655
  • Pulmonary Artery Stenosis: Etiology

    - Systematic vasculitis
    - Behcet disease
    - Takayasu arteritis
    - Inflammatory disease (TB, histoplasmosis)
  • Mycotic Pseudoaneurysm of the Pulmonary Artery

    - Right sided endocarditis
    - Necrotizing pneumonia
    - Syphilis
    - Tuberculosis (Rasmussen pseudoaneurysm)
  • Pulmonary Artery Aneurysms: Facts

    - Rare
    - May be congenital or required
    - Syphilis
    - Pulmonary hypertension is common
    - Complications are hemoptysis which can lead to rupture and may prove fatal

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