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Embolization of de novo pulmonary arteriovenous malformations (PAVMs) using high-volume detachable non-fibered (HVDNF) coils was compared to traditional non-HVDNF coils. Persistent-occlusion rates were evaluated. A total of 272 de novo (previously untreated) PAVM treatments were retrospectively stratified into those treated with non-HVDNF coils only (n = 192) and those treated with HVDNF coils with or without other coils (n = 80). Propensity score matching, followed by survival analysis and cost analysis, was performed. The overall persistent-occlusion rate was 86.0% (234/272). Persistent occlusion was achieved in 81.8% of PAVMs using non-HVDNF coils, compared with 96.3% using HVDNF coils (p = 0.0017). The mean follow-up was 30.7 ± 31.9 months versus 14.7 ± 13.4 months, respectively (p < 0.0001). Propensity-matched survival analysis demonstrated PAVMs treated with HVDNF coils recurred significantly less frequently than PAVMs treated with non-HVNDF coils (p = 0.023). The use of HVDNF coils was more expensive than standard coils, however not significantly different for the treatment of complex PAVMs. The use of high-volume detachable non-fibered coils was associated with higher persistent-occlusion rates when compared with non-HVDNF coils. HVDNF coils were more expensive on average; however, cost was similar between groups for the treatment of complex PAVMs.

Background: Registry data suggest women are less likely than men to undergo pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension despite a similar proportion of proximal vs distal disease. We hypothesized that sex-specific differences could be elicited with a computed tomography pulmonary angiography analysis beyond proximal vs distal. Methods: Preoperative computed tomography pulmonary angiography of patients who underwent pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension from January 2017 to September 2021 was analyzed. The pulmonary vascular tree was divided into 32 named vessels with chronic thromboembolism presence and lesion type recorded for each vessel. If no lesion was identified in a segmental vessel, subsegmental disease was recorded when present. Results: One hundred forty-four patients (mean age 57 ± 15 years, 78 women) were included. There were no sex differences in baseline hemodynamics. Men had more vessels involved than women (mean 20.3 vs 17.1, p = 0.004) and had fewer disease-free pulmonary segments (mean 4.9 ± 4.3 vs 7.6 ± 5.5, p = 0.001). Men had a greater number of webs, eccentric thickening, and occlusions. The distribution of lesion type did not significantly differ between sexes at the main or lobar level but men had significantly more lesions in the segmental vasculature while women had a higher proportion of subsegmental lesions (p

When the electrocardiogram of acute pulmonary embolism is similar to that of acute myocardial infarction, it is difficult to distinguish between the two diseases quickly and effectively. We present the case of a 50-year-old man with acute pulmonary embolism. His electrocardiogram showed subtotal occlusion of the left main coronary artery with ST segment depression in I, II, aVF, V3 to V6, ST segment elevation in aVR, V1 and S1Q3T3. Invasive coronary angiography did not show coronary artery stenosis, then pulmonary angiography was performed quickly which showed massive bilateral acute pulmonary embolism. Electrocardiogram cannot effectively distinguish acute pulmonary embolism from subtotal occlusion of the left main coronary artery. For patients with hemodynamic instability, if ultrasound cannot be performed in time, the combination of invasive coronary angiography and pulmonary angiography can be an option to distinguish acute pulmonary embolism from subtotal occlusion of the left main coronary artery and to treat.

Introduction: Acute pulmonary embolism is a life-threatening condition that can lead to sudden death. Pulmonary Artery Hypertension (PAH) can be found in the setting of acute pulmonary embolism. The Egg and Banana sign and Carina Crossover (CCO) sign are seen in PAH, which are present on Computed Tomographic scans (CT scans). Aim: To determine the accuracy of CT scans, the Egg and Banana sign, and CCO sign seen in PAH in the evaluation of pulmonary embolism. Materials and Methods: This retrospective, cross-sectional study was conducted from May 2019 to May 2021 in the Department of Radiodiagnosis at Father Muller Medical College Hospital in Mangalore, Karnataka, India. The CT scans of 102 consecutive patients who underwent CT Pulmonary Angiography (CTPA) for suspected pulmonary embolism were evaluated for the presence of the CCO sign and Egg and Banana sign. The CCO sign was considered positive when the right Pulmonary Artery (PA) was seen crossing anterior to the carina at its bifurcation. The Egg and Banana sign was considered present when the PA was found lateral to the aortic arch, with the PA described as the Egg and the arch as the Banana. The results were statistically analysed using Statistical Package for Social Sciences version 3.0. Results: Pulmonary embolism was seen in 26 out of 102 cases, with a mean age of 60.2±16.27 years. Pulmonary embolism was absent in 76 cases with a mean age of 55.8±17.11. An equal gender distribution was seen in 26 cases of pulmonary embolism. The Egg and Banana sign was found in 8 out of 26 patients with pulmonary embolism and had a specificity of 78.9%, negative predictive value of 76.92%, and diagnostic accuracy of 66%. The CCO sign was seen in 14 out of 26 cases of pulmonary embolism and had a higher specificity of 81.58% and diagnostic accuracy of 74.51%. The CCO sign had a statistically significant value in detecting pulmonary embolism. Conclusion: According to the study, the CCO sign had a higher accuracy in detecting pulmonary embolism compared to the Egg and Banana sign. The accuracy was further improved when combined with other signs of pulmonary embolism.

Objectives: To assess the validity of pre-test evaluation of patients with Modified Wells score at our facility to improve diagnostic yield of CT pulmonary angiography for pulmonary embolism. Study Design: Prospective longitudinal study. Place and Duration: Department of Computed Tomography, Armed Forces Institute of Radiology & Imaging, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Feb to Jul 2019. Methodology: After approval from the Ethical Review Board, 60 patients with clinical suspicion of pulmonary embolism were selected. Modified Wells score was calculated for each patient, and a senior consultant reviewed their CT Pulmonary Angiograms. Results: Sixty patients were assessed from February to July 2019. Pulmonary embolism was diagnosed in 21(35%) patients; 22(37%) patients were unremarkable, while alternate diagnosis was provided for 17(28%) patients. Modified Wells score was 66.6% sensitive and 74.3% specific for diagnosis of pulmonary embolism, with a positive predictive value of 58.3% and a negative predictive value of 80.5%. Conclusion: Modified Wells score carries a good negative predictive value for ruling out pulmonary embolism. Hospitals must devise their departmental protocol utilizing risk stratification tools, lab tests and other safer imaging alternatives, where applicable.

Pulmonary varix is a rare and usually asymptomatic localized dilation of a pulmonary vein. This disease should be distinguished from other pulmonary and mediastinal diseases, particularly pulmonary arteriovenous malformations. Herein, we encountered a case of pulmonary varix clearly demonstrated by 3-dimensional reconstructed computed tomography (3D-CT) which proved useful in its diagnosis. The 3D-CT enabled easy understanding of the vascular connections and confirmation of the absence of an inflow pulmonary artery. We also performed angiography which showed findings consistent with those obtained by the 3D-CT, thus confirming the diagnosis of pulmonary varix. After the diagnosis, the patient was followed up for several years without any treatment and she remained asymptomatic. On follow-up CT, the lesion remained unchanged.

We present unusual coronary-pulmonary collaterals in a 65-year-old CTEPH patient. Perfusion mapping of a dual-energy computed tomography (DECT) study revealed areas of right lung that were minimally perfused despite unilateral occlusion of the right pulmonary artery, leading to the discovery of coronary-pulmonary collaterals via invasive coronary angiography. Pulmonary thromboendarterectomy removed the clot en-bloc. Post-surgery DECT and catheterization confirmed restoration of pulmonary arterial circulation and excellent hemodynamic response. Here, suggestion of perfusion to a proximally obstructed lung with DECT helped to document the presence of rarely documented coronary-pulmonary artery collaterals.

A rare case of large 22 mm Pulmonary artery to Left atrial (PA-LA) fistula is described. Diagnosis on transthoracic echocardiography is highlighted. It is first report to depict common occurrence of PA-LA fistula with pulmonary vein varix. Managed successfully with transcatheter approach using Atrial Septal Defect closure device.

Chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary disease (CTEPD) are two terms characterizing symptomatic patients with chronic thromboembolic occlusions of pulmonary arteries with or without pulmonary hypertension at rest. Their diagnosis follows evolving schemas that integrate technological advances of pivotal imaging modalities among which computed tomography angiography plays a major role. This review article summarizes the current knowledge on the natural history of acute pulmonary embolism and its evolution toward chronic pulmonary embolism, as well as the imaging clues, for the identification of chronically obstructed pulmonary arteries. The requirements for imaging at the time of therapeutic decisions are also described in the light of recent updates in the literature from multidisciplinary groups of experts. Because an early diagnosis of CTEPH remains a challenge for the medical community, several practical issues are included in this article with the objective of improving the knowledge and collaboration between radiologists and clinicians in service to the patient. [ABSTRACT FROM AUTHOR]

Pulmonary thrombosis (PT) is a frequent complication of COVID-19. However, the risk factors, predictive scores, and precise diagnostic guidelines on indications for CT pulmonary angiography (CTPA) are still lacking. This study aimed to analyze the clinical and laboratory characteristics associated with PT in patients with COVID-19. We conducted a cohort study of consecutively hospitalized adult patients with COVID-19 who underwent CTPA at the University Hospital for Infectious Diseases in Zagreb, Croatia between 1 April and 31 December 2021. Of 2078 hospitalized patients, 575 (27.6%) underwent CTPA. PT was diagnosed in 178 (30.9%) patients (69.6% males, median age of 61, IQR 50–69 years). The PT group had a higher CRP, LDH, D-dimer, platelets, and CHOD score. PT was more frequent in patients requiring ≥15 L O2/min (25.0% vs. 39.7%). In multivariable analysis, only D-dimer ≥ 1.0 mg/L (OR 1.78, 95%CI 1.12–2.75) and O2 ≥ 15 L (OR 1.89, 95%CI 1.26–2.84) were associated with PT. PT was not associated with in-hospital mortality. In conclusion, our data confirmed a high incidence of PT in hospitalized patients with COVID-19, however, no correlation with traditional risk factors and mortality was found. CTPA should be performed in patients requiring high-flow supplemental oxygen or those with increased D-dimer levels. [ABSTRACT FROM AUTHOR]

Objective: To investigate the CT findings of pulmonary infarction (PI) secondary to acute pulmonary embolism (APE). Method: The clinical and CT data of 41 patients with PI secondary to APE were analyzed retrospectively. The number, location, shape, margin of PI, pleural effusion and dynamic changes were summarized. Results: CT features of PI: (1) Number and location: Among the total 79 PI lesions, 18 patients had single lesion and 23 patients had multiple lesions. All lesions were located under the pleura and connected to the pleura with a broad base, 46.8% (37/79) were located in the lower lobe of the right lung, 36.7% (29/79) in the lower lobe of the left lung, 3.8% (3/79) in the upper lobe, 6.3% (5/79) in the middle lobe of the right lung, and 6.3% (5/79) in the lingual segment of the upper lobe of the left lung. (2) Shape: 45.6% (36/79) of the lesions showed Reversed Halo Sign (RHS), 36.7% (29/79) displayed consolidation of oval, wedge or hump, 17.7% (14/79) revealed ground glass opacity. (3) Bronchovascular bundles in PI: Bronchovascular bundles were found in 79.7% (63/79) of PI. In 21.3% (16/79) of the cases, there was no bronchovascular bundle in the lesion because of its small size; (4) After enhancement, there was no enhancement shown in the 79 PI lesions. (5) All 79 lesions changed into patchy or linear during the end of the treatment period. (6) Pleural effusion: 63.4% (26/41) of patients had pleural effusion, among whom 42.3% (11/26) had bilateral pleural effusion, and 57.7% (15/26) had unilateral pleural effusion. Conclusion: The imaging manifeatations of PE secondary to API hole certain characteristics. For single or multiple lesions under the pleura, with RHS, consolidation of wedge or hump, bronchovascular bundles, APE secondary to API should be considered. In addition, pleural effusion is helpful for diagnosis.

Some occupation-related practices contribute significantly to the morbidity because both employer and employee are unaware of the risk. The authors have described two subjects with job profile of ticketing on board (bus conductors) who had a habit of sitting continuously at a designated conductor place for ticketing in their 8-h duty and rarely getting up in between. They presented with dyspnea in the outpatient department of pulmonary medicine without an antecedent history of any chronic ailment or family history of coagulopathy. These professionals had venous stasis, leading to pulmonary thromboembolism (PTE). PTE was diagnosed on the basis of contrast-enhanced computed tomography pulmonary angiography. The other causes of PTE were ruled out. They were treated as per the guidelines on PTE and were advised frequent walking in the bus during their duty hours. However, this has to be instructed to all the employees by the employer.

Some occupation-related practices contribute significantly to the morbidity because both employer and employee are unaware of the risk. The authors have described two subjects with job profile of ticketing on board (bus conductors) who had a habit of sitting continuously at a designated conductor place for ticketing in their 8-h duty and rarely getting up in between. They presented with dyspnea in the outpatient department of pulmonary medicine without an antecedent history of any chronic ailment or family history of coagulopathy. These professionals had venous stasis, leading to pulmonary thromboembolism (PTE). PTE was diagnosed on the basis of contrast-enhanced computed tomography pulmonary angiography. The other causes of PTE were ruled out. They were treated as per the guidelines on PTE and were advised frequent walking in the bus during their duty hours. However, this has to be instructed to all the employees by the employer. [ABSTRACT FROM AUTHOR]

Abstract Background Pulmonary embolism (PE) is a critical medical condition that requires prompt diagnosis and treatment to avoid serious morbidity and mortality risk. Multidetector CT pulmonary angiography (CTPA) is considered the first-line imaging modality for suspected acute PE. The presence of right heart strain, which supports the diagnosis, requires special attention. The aim of our retrospective study is to assess the reliability of CTPA hemodynamic indices in predicting patients’ outcome in cases of PE. Results Sixty patients were included in our study. CTPA parameters including main pulmonary artery (MPA) diameter, left ventricle (LV) diameter, right ventricle (RV)/LV ratio, and septal deviation had a clinical prognostic value for short-term 30-day mortality and ICU admission. Statistically significant relationship between MPA diameter > 29 mm, LV diameter, RV/LV ratio > 1, left-sided septal deviation and contrast reflux into the IVC/distal hepatic veins with ICU admission was observed with p values 0.031, 0.000, 0.000, 0.005 and 0.028 respectively. There was a statistically significant correlation between MPA diameter > 29 mm, LV diameter, RV/LV > 1 ratio and septal deviation with 30-day mortality with p values of

Pulmonary Arteriovenous Malformation (PAVM) is a cardiovascular anomaly in which an anatomic communication between the pulmonary artery and pulmonary vein is formed, resulting in an additional cardiac shunt from right to left side. PAVM is a rare disease, reported more in females, but in newborns comparatively higher in males. Cases can vary from asymptomatic to symptomatic such as having dyspnoea, hypoxia, cyanosis, neurological symptoms. They are mostly congenital having association with Hereditary Haemorrhagic Telangiectasia (HHT). Herby, author present a case of 18-months-old female admitted with peripheral cyanosis in the Paediatric Department. Her saturation level was 76%, after admission she received three doses of salbutamol nebulisation and was kept on 3 litre oxygen until her saturation increased to around 95%. On auscultation, a murmur of grade 2/6 heard in the left axilla with clear lung fields. Chest X-ray detected a prominent lobulated opacity in the left sided lung adjacent to the heart border. An echocardiogram was done which turned out normal. Thoracic Computed Tomography (CT) scan with contrast showed a vascular malformation in the apical region of the left lower lobe. Pulmonary angiography showed multiple vascular lesions in the peripheries which was consistent with arteriovenous malformation. The child was diagnosed with PAVM. A transcatheter embolisation and coil closure of AVM was performed and postprocedure the child was stable.

The usefulness of the parameters of biventricular function simultaneously measured using enhanced multi-detector computed tomography (MDCT) pulmonary angiography in patients with chronic thromboembolic pulmonary hypertension (CTEPH) has not been clarified. This study aimed to verify the correlation between left and right ventricular (RV) parameters and pulmonary vascular resistance (PVR). Patients who underwent enhanced MDCT before diagnostic right heart catheterization at Nagoya University Hospital between October 2014 and April 2021 were enrolled. The correlation of biventricular function and volume parameters with PVR was assessed. Eighty patients were retrospectively analyzed. Patients' mean age was 65 ± 13 years, mean PVR was 9.1 (range, 6.1–11.3) Wood units, and mean end-systolic eccentricity index (esEI) was 1.76 ± 0.50. RV end-systolic volume (ESV) (p = 0.007), RV cardiac output (CO) (p < 0.001), RV ejection fraction (p < 0.001), LV end-diastolic volume (EDV) (p < 0.001), left ventricular (LV) ESV (p = 0.006), LVCO (p < 0.001), end-diastolic EI (p < 0.001), and esEI (p < 0.001) were significantly correlated with PVR. The LVEDV (p = 0.001) and esEI (p < 0.009) were independent predictors of PVR. Systolic pulmonary arterial pressure (PAP) (p < 0.001), diastolic PAP (p < 0.001), mean PAP (p < 0.001), right atrial pressure (p < 0.023), and PVR (p < 0.001) were significantly higher in the high esEI group than in the low esEI group. The esEI was a simple predictor of CTEPH severity. [ABSTRACT FROM AUTHOR]

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Abstract Percutaneous pulmonary angiography may be used for early diagnosis of pulmonary embolism in the hemodynamic unstable patient. Pulmonary embolectomy is an effective treatment option in patients with acute high‐risk pulmonary embolism.

Bronchial artery embolization is an effective nonsurgical therapy for massive hemoptysis. Routine selection of the bronchial arteries from the aorta usually enables the interventionalist full interrogation and embolization of the culprit vascular abnormality. In problematic cases where bronchial artery access is difficult, a systemic-to-pulmonary arterial shunt can be exploited as a retrograde means of vascular intervention. A case is presented where inaccessibility of a tortuous left bronchial artery was circumvented by accessing the left pulmonary artery, leading to successful embolization and control of hemoptysis.

Background Patients with sleep apnea (SA) experience repeated episodes of hypoxia interspersed with intervals of reoxygenation that may have systemic implications. Thus, this study aimed to determine the prevalence of SA in patients presented with pulmonary embolism (PE). Patients and methods In all, 120 patients with first-episode acute PE confirmed by pulmonary angiography were included in this study. Simplified pulmonary embolism severity index was determined at the time of PE diagnosis. Full-night polysomnography was performed. Patients were divided into two groups: the low risk (n=70) and the high risk (n=50). Results Regarding the distribution of the patients according to their simplified pulmonary embolism severity index risk class, 38 (54%) of the low-risk group had SA while 23 (46%) of the high-risk group had SA. The overall prevalence of SA among patients presented with PE was 50.8%. The severity of SA was determined by apnea–hypopnea index; 59 (49.2%) normal, 20 (16.7%) mild, 18 (15%) moderate, and 23 (19.1%) severe. BMI, and neck and waist circumference were significantly increased among the high-risk group. The most frequent clinical presentation among the high-risk group PE was snoring (48%) and excessive sleepiness (36%), respectively. Witnessed apnea was not different between both groups. Also, Epworth sleepiness scale scale reported higher scores. Regarding polysomnography recordings, stages 1 and 2 and rapid eye movement sleep were significantly different in both groups, while apnea–hypopnea index, desaturation index, and time spent with oxygen saturation less than 90% were significantly increased in the high-risk group PE. Conclusion SA is a common prevalent disorder among patients with PE. Snoring and excessive daytime sleepiness were a frequent complaint in the high-risk group PE. Hence, these findings support the concept of association between obstructive sleep apnea and PE. However, obstructive sleep apnea should be evaluated for all patients with the unidentifiable cause of PE.

Obstruction of the pulmonary artery or one of its branches, often due to thrombi from the deep veins of the lower extremities can result in a life-threatening condition known as pulmonary embolism. Pulmonary infarction, an unusual complication of pulmonary embolism occurs when the blood supply to lung tissue is obstructed, leading to tissue necrosis. An 80-year-old man presented with a cough, breathlessness, and generalized weakness. He was vitally stable with no oxygen requirement, which could have suggested an infective etiology like pneumonia or tuberculosis. However, the presence of calf tenderness prompted us to perform a venous Doppler ultrasonography, which revealed deep venous thrombosis. This, combined with right atrial and ventricular dilation and moderate pulmonary artery hypertension observed on transthoracic echocardiography (2D ECHO), led us to recommend a CT pulmonary angiography. The angiography revealed an uncommon presentation of pulmonary embolism with multiple pulmonary infarcts. Here, we chronicle an unusual case of pulmonary infarction secondary to pulmonary embolism, which presented radiologically as consolidation with an aseptic cavity, a rare and atypical triple occurrence., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nilgiri K. et al.)

Background: Pulmonary embolism (PE) is a critical medical condition that requires prompt diagnosis and treatment to avoid serious morbidity and mortality risk. Multidetector CT pulmonary angiography (CTPA) is considered the first-line imaging modality for suspected acute PE. The presence of right heart strain, which supports the diagnosis, requires special attention. The aim of our retrospective study is to assess the reliability of CTPA hemodynamic indices in predicting patients' outcome in cases of PE. Results: Sixty patients were included in our study. CTPA parameters including main pulmonary artery (MPA) diameter, left ventricle (LV) diameter, right ventricle (RV)/LV ratio, and septal deviation had a clinical prognostic value for short-term 30-day mortality and ICU admission. Statistically significant relationship between MPA diameter > 29 mm, LV diameter, RV/LV ratio > 1, left-sided septal deviation and contrast reflux into the IVC/distal hepatic veins with ICU admission was observed with p values 0.031, 0.000, 0.000, 0.005 and 0.028 respectively. There was a statistically significant correlation between MPA diameter > 29 mm, LV diameter, RV/LV > 1 ratio and septal deviation with 30-day mortality with p values of < 0.001, 0.001, < 0.001 and 0.015 respectively. No significant correlation was found between 30-day mortality and contrast reflux to IVC with p value of 0.070. Conclusions: CTPA measurements including MPA diameter, RV/LV ratio and septal deviation were found to be significantly correlated to ICU admission and 30-day mortality as predictors for PE severity. CT contrast reflux was found to be correlated to ICU admission; however, it was not significantly correlated to 30-day mortality. [ABSTRACT FROM AUTHOR]

Pulmonary Arteriovenous Malformation (PAVM) is a cardiovascular anomaly in which an anatomic communication between the pulmonary artery and pulmonary vein is formed, resulting in an additional cardiac shunt from right to left side. PAVM is a rare disease, reported more in females, but in newborns comparatively higher in males. Cases can vary from asymptomatic to symptomatic such as having dyspnoea, hypoxia, cyanosis, neurological symptoms. They are mostly congenital having association with Hereditary Haemorrhagic Telangiectasia (HHT). Herby, author present a case of 18-months-old female admitted with peripheral cyanosis in the Paediatric Department. Her saturation level was 76%, after admission she received three doses of salbutamol nebulisation and was kept on 3 litre oxygen until her saturation increased to around 95%. On auscultation, a murmur of grade 2/6 heard in the left axilla with clear lung fields. Chest X-ray detected a prominent lobulated opacity in the left sided lung adjacent to the heart border. An echocardiogram was done which turned out normal. Thoracic Computed Tomography (CT) scan with contrast showed a vascular malformation in the apical region of the left lower lobe. Pulmonary angiography showed multiple vascular lesions in the peripheries which was consistent with arteriovenous malformation. The child was diagnosed with PAVM. A transcatheter embolisation and coil closure of AVM was performed and postprocedure the child was stable. [ABSTRACT FROM AUTHOR]

Peripheral vascular disease, chronic large-bore venous access, and small body habitus can limit traditional venous access methods for right heart catheterization. We present a patient with chronic renal failure, small body habitus due to developmental delay, and multiple central vein stenoses due to chronic indwelling catheters and heparin-induced thrombocytopenia, who required right heart catheterization for workup of possible intracardiac shunt, pulmonary hypertension, and pulmonary embolism. We performed right heart catheterization and pulmonary angiography via transhepatic approach. The hepatic vein was accessed with a Chiba biopsy needle, and hepatic vein access was confirmed by contrast injection under fluoroscopy. A long 8-French sheath was advanced to the cavoatrial junction, and a balloon-tipped right heart catheter was used for pressure measurement, serial oxygen saturations, and angiography. Pulmonary pressures and angiography were normal, and there was no intracardiac shunt. Access-tract hemostasis was achieved with vascular plugs, embolization coils, and manual pressure. We demonstrate successful right heart catheterization and pulmonary angiography via transhepatic access. This is a valuable alternative access for patients with limited traditional options. [ABSTRACT FROM AUTHOR]

Abstract Background Surgeries requiring one-lung ventilation (OLV) in patients with Fontan circulation pose great challenges. However, little information is available regarding the safety of OLV in Fontan patients when hemidiaphragmatic paralysis is present. Case presentation A 41-year-old woman who underwent repeated Fontan procedures was re-admitted to our hospital because of worsening shortness of breath. As left hemidiaphragmatic paralysis was considered to be contributing to her symptom, an open thoracic left diaphragmatic plication surgery was scheduled. A preoperative pulmonary artery angiogram revealed a remarkably reduced blood flow to the left lung. The surgeon requested OLV during the surgery. Despite our concern regarding the impact of OLV on the Fontan circulation, OLV did not result in major hemodynamic changes. Conclusion OLV can be safely implemented in patients with hemidiaphragmatic paralysis with preserved Fontan circulation. Preoperative pulmonary artery angiography may provide useful information for estimating the impact of OLV on the Fontan circulation.

Introduction: Venous Thromboembolism (VTE) encompasses a wide spectrum consisting predominantly of deep venous thrombosis and pulmonary embolism. The value of Fibrin Degradation Product (FDP) of which, most common is D-dimer which is most commonly deployed to pre-diagnose venous thrombosis. Diagnosing it has always been a hard effort. It is produced when cross-linked fibrin is broken down; among patient who is suspected of having pulmonary embolism, blood D-dimer levels correlate with the probability of having pulmonary embolism. Aim: This study was done to analyse the sensitivity of plasma D-dimer for VTE. Materials and Methods: Retrospective case study of 76 patients with VTE in form of pulmonary embolism done at the Dhiraj Hospital, Sumandeep Vidyapeeth Deemed University, Vadodara from January 2019 to January 2020 for a period of one year. Prethrombolytic plasma was withdrawn and D-dimer quantification were measured using fully automatic stago coagulometer instruement (STA Compact Max). Sensitivity, Specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) was calculated and formulated in tables and graphs. Results: The sensitivity, NPV, specificity and PPV of the D-dimer was 95.65%, 76.92%, 66.66% and 92.95%, respectively. CT pulmonary angiography had a specificity of 80%, sensitivity of 92.75%, a NPV of 70.58% and a PPV of 95.52%. Conclusion: D-dimer is mostly the go to test for ruling out VTE especially pulmonary embolism, if the pre-test probability is intermediate. Rationale use of this test does help in prognostification and helps to achieve therapeutics faster and more effectively.

The usefulness of the parameters of biventricular function simultaneously measured using enhanced multi-detector computed tomography (MDCT) pulmonary angiography in patients with chronic thromboembolic pulmonary hypertension (CTEPH) has not been clarified. This study aimed to verify the correlation between left and right ventricular (RV) parameters and pulmonary vascular resistance (PVR). Patients who underwent enhanced MDCT before diagnostic right heart catheterization at Nagoya University Hospital between October 2014 and April 2021 were enrolled. The correlation of biventricular function and volume parameters with PVR was assessed. Eighty patients were retrospectively analyzed. Patients’ mean age was 65 ± 13 years, mean PVR was 9.1 (range, 6.1–11.3) Wood units, and mean end-systolic eccentricity index (esEI) was 1.76 ± 0.50. RV end-systolic volume (ESV) (p = 0.007), RV cardiac output (CO) (p < 0.001), RV ejection fraction (p < 0.001), LV end-diastolic volume (EDV) (p < 0.001), left ventricular (LV) ESV (p = 0.006), LVCO (p < 0.001), end-diastolic EI (p < 0.001), and esEI (p < 0.001) were significantly correlated with PVR. The LVEDV (p = 0.001) and esEI (p < 0.009) were independent predictors of PVR. Systolic pulmonary arterial pressure (PAP) (p < 0.001), diastolic PAP (p < 0.001), mean PAP (p < 0.001), right atrial pressure (p < 0.023), and PVR (p < 0.001) were significantly higher in the high esEI group than in the low esEI group. The esEI was a simple predictor of CTEPH severity.

When the electrocardiogram of acute pulmonary embolism is similar to that of acute myocardial infarction, it is difficult to distinguish between the two diseases quickly and effectively. We present the case of a 50-year-old man with acute pulmonary embolism. His electrocardiogram showed subtotal occlusion of the left main coronary artery with ST segment depression in I, II, aVF, V3 to V6, ST segment elevation in aVR, V1 and S1Q3T3. Invasive coronary angiography did not show coronary artery stenosis, then pulmonary angiography was performed quickly which showed massive bilateral acute pulmonary embolism. Electrocardiogram cannot effectively distinguish acute pulmonary embolism from subtotal occlusion of the left main coronary artery. For patients with hemodynamic instability, if ultrasound cannot be performed in time, the combination of invasive coronary angiography and pulmonary angiography can be an option to distinguish acute pulmonary embolism from subtotal occlusion of the left main coronary artery and to treat., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Percutaneous pulmonary angiography may be used for early diagnosis of pulmonary embolism in the hemodynamic unstable patient. Pulmonary embolectomy is an effective treatment option in patients with acute high‐risk pulmonary embolism. [ABSTRACT FROM AUTHOR]

Background: Heart failure is a clinical diagnosis characterised by non-specific symptoms such as dyspnoea, fatigue and oedema. The aim of this pilot study was to investigate what role computed tomography pulmonary angiography could play in supporting a diagnosis of heart failure when a pulmonary embolism has been excluded. Methods: This was a prospective study using the National Integrated Medical Imaging System to assess the potential of computed tomography pulomary angiography (CTPA) as a diagnostic test for heart failure. Consecutive patients were collected from three hospitals of the University of Limerick Hospital Group. We reviewed 230 consecutive CTPA results for cardiac and lung features. Of these, we confirmed which had heart failure by comparison with brain natriuretic peptide (BNP) and echocardiogram criteria. Exclusion criteria included any patients with a diagnosis of pulmonary embolism. Results: Of these 230 patients, only 24 (10.4%) had both objective and clinical signs of heart failure. The most specific signs were shown to be left ventricular enlargement, left atrial enlargement and right ventricular enlargement, which approximated a specificity of 100% (CI 66.3–100.00%). CTPA was shown to match gold standard echocardiography closely in detecting abnormalities as per chi square; Right ventricular enlargement (value = 5.426 P = 0.02), left atrial enlargement (value = 4.9 P = 0.027) and left ventricular enlargement (value = 5.692 P = 0.017). Conclusion: Findings on CTPA which included left ventricular enlargement, left atrial enlargement and right ventricular enlargement were shown to be specific for a diagnosis of heart failure. CTPA should be used by physicians awaiting echocardiography to help guide treatment in cases of suspected heart failure. [ABSTRACT FROM AUTHOR]

Objectives: Massive and sub-massive pulmonary embolisms (PEs) are associated with high mortality and morbidity. The mainstay of treatment for PE is anticoagulation. However, high- and intermediate-risk patients may benefit from interventional thrombolytic therapy. Computed tomography pulmonary angiography (CTPA) is widely available, fast, and non-invasive technique, and it can identify pulmonary thrombus down to at least a segmental level. In this study, we attempt to evaluate the efficacy of CTPA as a non-invasive imaging biomarker for risk stratification of acute PE (APE) patients. Material and Methods: This is a prospective study conducted on 150 patients who proved to have APE by CTPA. The simplified PE severity index score was obtained. The pulmonary artery obstruction index (PAOI) using and right to left ventricular (RV/LV) diameter ratios were calculated. Results: The patients were divided into (1) high risk (shocked) and (2) non-high risk groups. There was a significant difference between the 1st and 2nd groups regarding PAOI. Hemodynamically stable patients were further subclassified according to the right ventricular dysfunction (RVD) into Group Ia (intermediate risk) and Group Ib (low risk). There was a significant difference between subgroups regarding PAOI (P < 0.0001, r = 0.385). Receiver operating characteristic curve analysis revealed PAOI >47% associated with RV/LV ratio >1. Conclusion: Our results support the use of CTPA as a surrogate imaging biomarker for both diagnosis and risk stratification of APE patients. CTPA allows assessment of clot burden through PAOI calculation and identification of intermediate-risk PE through the assessment of RVD. [ABSTRACT FROM AUTHOR]

Transthoracic parametric Doppler (TPD), unlike conventional ultrasonography, measures signals originating from movements of pulmonary blood vessel walls. In this pilot study, we tested TPD in 15 patients diagnosed with pulmonary embolism on computed tomography pulmonary angiography. Results were mapped to the upper, middle, and lower thirds of the right lung. In the lower third, TPD yielded 100% specificity and positive predictive value for acute pulmonary embolism. If validated in a larger series, this rapid bedside technique might obviate the need for computed tomography in specific cases. This could be advantageous in patients who are unstable, in intensive care, or have allergies to iodinated contrast material. [ABSTRACT FROM AUTHOR]

In pulmonary angiography, the heartbeat creates artifacts that hinder extraction of blood vessel images in digital subtraction angiography. Remasking according to the cardiac phase of the angiogram may be effective but has yet to be automated. Here, automatic remasking was developed and assessed according to the cardiac phase from electrocardiographic information collected simultaneously with imaging. Manual remasking, fixed remasking, and our proposed automatic remasking were applied to 14 pulmonary angiography series from five participants with either chronic thromboembolic pulmonary hypertension or pulmonary arteriovenous malformation. The processing time and extent of artifacts from the heartbeat were compared. In addition, the peak signal-to-noise ratio (PSNR) was measured from differential images between mask image groups before the injection of the contrast medium to investigate optimal mask images. The mean time required for automatic remasking was 4.7 s/series, a significant reduction in processing time compared with the mean of 266 s/series for conventional manual processing. A visual comparison of the different approaches showed virtually no misregistration artifacts from the heartbeat in manual or automatic remasking according to cardiac phase. The results from measuring the PSNR for differential images between mask image groups also showed that smaller cardiac phase difference and time difference between two images ensure higher PSNR (p < 0.01). Automatic remasking according to the cardiac phase was fast and easy to implement and reduced misregistration artifacts from heartbeat. [ABSTRACT FROM AUTHOR]

Objective: The aim of the work was directed to evaluate the value of multi-detector computed tomography pulmonary angiography study in evaluation of known patients with Behcet’s disease. Materials and methods: This study was done retrospectively and included eighteen known patients with Behcet’s disease and referred for MDCT pulmonary angiography. Results: Pulmonary artery aneurysm was the most common finding as it was found in 16 patients, followed by pulmonary embolism which was found in 14 patients, 12 patients with pulmonary hypertension, right ventricular strain in 6 patients, intracardiac thrombus in 4 patients, dilated bronchial arteries in 8 patients, venous occlusion in 4 patients, mosaic attenuation of the lung in 12 patients, pulmonary infarcts in 4 patients, and pleural effusion in 4 patients. Conclusion: MDCT pulmonary angiography is an important diagnostic imaging tool for diagnosis of vascular complications in patients with Behcet’s disease.

Objective: To compare between echocardiography and CT pulmonary angiography (CTPA) in the detection of pulmonary hypertension in patients with chronic advanced lung diseases. Method: 45 pateints with diagnosis of chronic advanced lung diseases were recuited in the sudy. Data of all patients were collected including patients' demographic characteristics, and the results of investigations which were performed for each patient which includes echocardiography and computerized tomography pulmonary angiography. Results: mean age of patients 53.4 ± 8.3 years, with two thirds of patients aged >50 years. Males were relatively dominant than females; 24 (53.3%) vs. 21 (46.7%) respectively. Majority of the cases (75.6%) were smokers,13 cases (28.9%) were employed. 71.1% of the cases had COPD. The mean pulmonary artery diameter of all cases was 26.3 ± 3.8 mm. The main pulmonary artery (MPA) to aorta (AO) ratio was elevate > 1:1 in 48.9% of cases. Right ventricle wall thickness = 4 mm in 16 cases (35.6%). Conclusion: This study has shown that although CT and echocardiographic measurements are both moderately strong correlates of mPAP in patients with a spectrum of underlying disorders, using these tests in combination is considerably more powerful in determining increased pulmonary arterial pressure than either test in isolation. [ABSTRACT FROM AUTHOR]

Objectives: To assess the validity of pre-test evaluation of patients with Modified Wells score at our facility to improve diagnostic yield of CT pulmonary angiography for pulmonary embolism. Study Design: Prospective longitudinal study. Place and Duration: Department of Computed Tomography, Armed Forces Institute of Radiology and Imaging, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Feb to Jul 2019. Methodology: After approval from the Ethical Review Board, 60 patients with clinical suspicion of pulmonary embolism were selected. Modified Wells score was calculated for each patient, and a senior consultant reviewed their CT Pulmonary Angiograms. Results: Sixty patients were assessed from February to July 2019. Pulmonary embolism was diagnosed in 21(35%) patients; 22(37%) patients were unremarkable, while alternate diagnosis was provided for 17(28%) patients. Modified Wells score was 66.6% sensitive and 74.3% specific for diagnosis of pulmonary embolism, with a positive predictive value of 58.3% and a negative predictive value of 80.5%. Conclusion: Modified Wells score carries a good negative predictive value for ruling out pulmonary embolism. Hospitals must devise their departmental protocol utilizing risk stratification tools, lab tests and other safer imaging alternatives, where applicable. [ABSTRACT FROM AUTHOR]

• A novel strategy to reuse available computed tomography pulmonary angiography (CTPA) scans to train a convolutional neural network for pulmonary embolism (PE) detection and segmentation • The algorithm uses deep learning but does not require manual outlines of the PE regions. • The CNN model trained on a large dataset without manual outlining demonstrated a better performance than the same CNN model trained on a small dataset with manual outlining. • Traditional computer vision algorithms can be leveraged to identify high-confident regions of interest for deep learning. We present a novel computer algorithm to automatically detect and segment pulmonary embolisms (PEs) on computed tomography pulmonary angiography (CTPA). This algorithm is based on deep learning but does not require manual outlines of the PE regions. Given a CTPA scan, both intra- and extra-pulmonary arteries were firstly segmented. The arteries were then partitioned into several parts based on size (radius). Adaptive thresholding and constrained morphological operations were used to identify suspicious PE regions within each part. The confidence of a suspicious region to be PE was scored based on its contrast in the arteries. This approach was applied to the publicly available RSNA Pulmonary Embolism CT Dataset (RSNA-PE) to identify three-dimensional (3-D) PE negative and positive image patches, which were used to train a 3-D Recurrent Residual U-Net (R2-Unet) to automatically segment PE. The feasibility of this computer algorithm was validated on an independent test set consisting of 91 CTPA scans acquired from a different medical institute, where the PE regions were manually located and outlined by a thoracic radiologist (>18 years' experience). An R2-Unet model was also trained and validated on the manual outlines using a 5-fold cross-validation method. The CNN model trained on the high-confident PE regions showed a Dice coefficient of 0.676±0.168 and a false positive rate of 1.86 per CT scan, while the CNN model trained on the manual outlines demonstrated a Dice coefficient of 0.647±0.192 and a false positive rate of 4.20 per CT scan. The former model performed significantly better than the latter model (p<0.01). The promising performance of the developed PE detection and segmentation algorithm suggests the feasibility of training a deep learning network without dedicating significant efforts to manual annotations of the PE regions on CTPA scans. [Display omitted] [ABSTRACT FROM AUTHOR]

We present a rare variant of pulmonary arteriovenous (AV) fistula (malformation), right pulmonary artery (RPA) to left atrium (LA) fistula, with its clinical and imaging findings with multidetector computed tomography (MDCT) pulmonary angiography and dynamic 3.0 T magnetic resonance imaging (MRI) pulmonary angiography in a 2-year-old female child who presented with central cyanosis at the age of 18 months.