Asunto(s)
Humanos , Femenino , Adulto , Seno Coronario/patología , Arteria Coronaria Izquierda Anómala/patología , Arteria Coronaria Izquierda Anómala/diagnóstico por imagen , Hernia Umbilical/cirugía , Arteria Ilíaca/patología , Arteria Ilíaca/diagnóstico por imagen , Factores de Tiempo , Ecocardiografía/métodos , Cateterismo Cardíaco/métodos , Evolución Clínica/métodos , Fístula Arterio-Arterial/diagnóstico por imagen , Cuidados Posteriores , Angiografía por Resonancia Magnética/métodos , Ecocardiografía Doppler en Color/métodos , Electrocardiografía , Angiografía por Tomografía Computarizada/métodosRESUMEN
We present a case of asymptomatic bronchial artery aneurysm that formed a fistula with part of the pulmonary artery (there was no definite fistula with the pulmonary vein). We were able to catheterize the feeding vessel but could not reach the aneurysm. We therefore injected a mixture of N-butyl-2-cyanoacrylate (NBCA; Histoacryl, B. Braun, Melsungen, Germany) and iodized oil (Lipiodol; Guerbet, Aulnay-sous-Bois, France) from the feeding vessel. The fistula, aneurysm, and feeding vessel were almost totally occluded. After embolization, the patient coughed a little; there were no other definite side effects or complications. One and 3 months later, on chest CT, the aneurysm was almost completely occupied with hyperattenuating NBCA-Lipiodol embolization. NBCA is a liquid embolization material whose time to coagulation after injection can be controlled by diluting it with Lipiodol. It is therefore possible to embolize an aneurysm, feeding vessels, and efferent vessels (in our case, it was a fistula) by using an NBCA-Lipiodol mixture of an appropriate concentration, regardless of whether the catheter can reach the aneurysm or not.
Asunto(s)
Aneurisma/terapia , Arterias Bronquiales , Quimioembolización Terapéutica , Cianoacrilatos/uso terapéutico , Aceite Yodado/uso terapéutico , Adulto , Aneurisma/diagnóstico por imagen , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/terapia , Fístula Arterio-Arterial/diagnóstico por imagen , Fístula Arterio-Arterial/terapia , Arterias Bronquiales/anomalías , Arterias Bronquiales/diagnóstico por imagen , Enbucrilato , Femenino , Humanos , Inyecciones Intravenosas , Arteria Pulmonar/anomalías , Arteria Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To investigate the interrelationships between the bronchial and pulmonary circulations including the existence of precapillary bronchopulmonary arterial anastomoses. MATERIAL AND METHODS: CT of bronchial arteriography (BAG-CT) was performed in 10 patients and BAG-CT during a pulmonary artery block test (PA-block) in 5 patients with lung cancer. Bronchial and pulmonary circulations were evaluated in 5 autopsied normal lungs by injecting silicone rubber with different colors into the bronchial and pulmonary arteries. RESULTS: BAG-CT correlated well with the findings at silicone rubber injection into lung autopsy samples. BAG-CT demonstrated inflow of contrast medium into the pulmonary artery during PA-block in all cases, while no inflow was observed before and following reversal of PA-block. Mixed silicone rubber was observed in the lobar to subsubsegmental bronchial arteries in all cases and in the subsubsegmental pulmonary artery in one case. CONCLUSION: Precapillary bronchopulmonary arterial anastomoses may exist at the level of the lobar bronchi to the periphery. If either the pulmonary or bronchial circulation is disturbed, flow occurs inside the anastomoses to supplement the other flow, especially flow from the bronchial to the pulmonary arteries via the anastomoses, which occurs within 30 min.