Does Bronchial Artery Hypertrophies After Descending Thoracic Aorta Stenting in Takayasu Arteritis? - A Clinical Dilemma.

41-year-old lady, known case of Takayasu arteritis with pulmonary arterial involvement, presented with multiple episodes of haemoptysis (maximum 50 mL) in a week. She had undergone descending thoracic aorta angioplasty and stenting 3 years ago due to uncontrolled hypertension, left ventricular systolic dysfunction and approximately 70% stenosis of descending thoracic aorta. This lady was treated with embolization of hypertrophied bronchial artery as well as left internal mammary artery branch for management of haemoptysis. Embolization of hypertrophied bronchial artery in the setting of Takayasu arteritis with pulmonary arterial involvement presenting with haemoptysis is rare. Hypertrophied bronchial artery detected in post stenting computed tomography raises suspicion whether descending thoracic aorta stenting promotes the hypertrophy of bronchial artery. Literature of bronchial artery embolization in the setting of Takayasu with post DTA stenting is scarce.

Common arterial trunk (Van Praagh type A3), absent right pulmonary artery and right aortic arch in a cyanotic child.

A 5-year-old girl with cyanotic congenital heart disease underwent computed tomography which revealed common arterial trunk from both ventricles with origin of the left pulmonary artery from the common trunk and right lung supplied by aorto-pulmonary collaterals with absent pulmonic valve and right pulmonary artery entirely. There was right-sided aortic arch with common origin of the left innominate artery and right common carotid artery.

Pictorial review of computed tomography and magnetic resonance imaging findings of cardiovascular manifestations of IgG4-related disease.

This study includes a series of 5 cases demonstrating cardiovascular manifestations of findings of IgG4-related disease. Two cases demonstrate peri-aortic soft tissue thickening in the infrarenal abdominal aorta and bilateral ostio--proximal common iliac artery. In 2 cases there were circumferential soft tissue lesions around the arch of the aorta. One of the cases showed coexistent, biopsy-proven Riedel's thyroiditis and infiltrative soft tissue along the right atrial wall and interatrial septum. In one case there was a partly calcified mass in the left hemi-thorax consistent with a diagnosis of IgG4-related fibrosing mediastinitis.

CT-Based Screening for Pulmonary Metastases in Head and Neck Squamous Cell Cancers: Diagnostic Accuracy and Cost Comparison with PET-CECT.

This study's objective was to compare detection rates of radiograph, computed tomography (CT), and positron emission tomography-contrast-enhanced computed tomography (PET-CECT) for pulmonary metastasis/synchronous primary lung tumors in head and neck squamous cell cancer (HNSCC) and its association with clinico-radio-pathological factors. Our retrospective study included 837 HNSCC patients from January 2012 to December 2017. Lung nodules were characterized on CT as benign, indeterminate, and metastatic. The true detection rate and statistical significance of associated risk factors were calculated. Risk factors for metastasis were determined using univariate and multivariate logistic regression models. Seventy-five (8.9%) patients had pulmonary metastasis and 3 (0.3%) had second lung primary. Detection rate of pulmonary metastasis by CT was higher (sensitivity-97.3%, specificity-97.2%) as compared to radiograph (sensitivity 49% and specificity 89%). Correlation was found between pulmonary and extra-pulmonary metastasis and N classification (P = 0.01, P = 0.02) and positive low jugular node (P = 0.001, P = 0.001). Using PET-CECT in place of CT costed an extra outlay of 7,033,805 INR (95,551.85 USD) while detecting distant metastasis in only 4 (0.47%) extra cases. Chest CT is a useful pulmonary metastases screening tool in advanced HNSCC patients with reasonable imaging cost as compared to PET-CT.

Split right coronary artery and shepherd's crook course of direct origin of the conal artery: An unhitherto association in a case of rheumatic mitral stenosis.

In a 47-year-old lady, planned for redo percutaneous mitral commissurotomy for recurrent mitral valve stenosis, there was incidental detection of splitting of right coronary artery and direct origin and shepherd's crook course of the conal artery. Though these two anomalies have no hemodynamic significance, correct nomenclature and potential clinical implications have been described.

Double chamber right ventricle with perimembranous VSD with sinus of valsalva aneurysm-An unhitherto assosciation.

BACKGROUND: Double chambered right ventricle with perimembranous ventricular septal defect is rare. AIMS AND MATERIAL METHODS: We report a case of double chambered right ventricle, perimembranous ventricular septal defect with nonruptured sinus of valsalva aneurysm in a 17 year old acyanotic male. RESULTS, DISCUSSION: On transthoracic echocardiography subaortic ventricular septal defect potentially restricted by prolapse of right coronary sinus was found. Computed tomography angiography revealed perimembranous ventricular septal defect, unruptured right sinus of valsalva aneurysm, prolapsing into right ventricle through membranous septal defect. Thick muscular band was dividing right ventricle into two chambers-suggestive of double chamber right ventricle. CONCLUSION: We report a case of double chambered right ventricle with perimembranous ventricular septal defect and nonruptured sinus of valsalva aneurysm, this combination is not reported in literature prior.

Interventricular membranous septal aneurysm is seen on multidetector computed tomography in postoperative child.

BACKGROUND: Ruptured interventricular septal aneurysms are rare. We present a case of an interventricular membranous septal aneurysm in a 7-year-old boy who presented with features of congestive heart failure, 2 years after undergoing a patch closure of perimembranous ventricular septal defect and tricuspid valve repair. Material and methods and results: Transthoracic echocardiography suggested the presence of an aneurysm that has ruptured into the right ventricle (RV), however, the precise origin of the aneurysm could not be identified on echocardiography. Subsequently, a computed tomography (CT) angiography was done which revealed that the aneurysm was originating from the membranous interventricular septum with evidence of rupture into the RV inflow. DISCUSSION: Due to its close proximity to the aortic annulus, an aneurysm of the membranous interventricular septum may be confused with a sinus of Valsalva aneurysm, especially if the former is associated with aortic regurgitation. CONCLUSION: This case highlights the importance of CT in the precise differentiation of these two abnormalities.

Berry syndrome with bovine aortic arch.

We present a case of berry syndrome and bovine aortic arch in a 2-month old child, detected on multidetector computed tomography.

Unruptured sinus of valsalva aneurysm in a case of large vessel vasculitis: A diagnostic dilemma.

BACKGROUND: Takayasu arteritis and tuberculous aortitis, both can result in aneurysmal disease of the aorta. The overlapping imaging features in case of large vessel vasculitis can create a diagnostic dilemma. AIM: We present a case of large vessel vasculitis and chronic empyema with unruptured sinus of valsalva aneurysm. METHODS AND RESULTS: A 30-year-old man presented with acute onset shortness of breath, palpitations, and gradually progressing pedal edema. The echocardiography and CT angiogram revealed features of large vessel vasculitis and chronic empyema along with unruptured sinus of valsava aneurysms. Patient underwent emergency Bentall procedure and the histopathology confirmed the diagnosis of takayasu arteritis. DISCUSSION: Tuberculosis being an endemic disease with varied presentations should always be considered a differential diagnosis, whenever appropriate. An unruptured sinus of valsalva aneurysm can be clinically silent or can cause compression symptoms. Although there are no specific guidelines regarding surgical correction, symptomatic and aneurysms of size >5.5cm are usually managed surgically. CONCLUSION: Unruptured sinus of valsalva aneurysms can be seen in Takayasu arteritis, which complicates the methodology and timing of the surgical management.