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1.
Zhonghua Er Ke Za Zhi ; 58(1): 25-29, 2020 Jan 02.
Artigo em Chinês | MEDLINE | ID: mdl-31905472

RESUMO

Objective: To improve the diagnosis and therapy of childhood pulmonary thromboembolism (PTE) by analyzing the clinical features of this rare condition. Methods: A total of 8 pediatric patients (4 males, 4 females) with PTE diagnosed in the Children's Hospital of Zhejiang University School of Medicine from March, 2014 to March, 2019 were enrolled. The clinical manifestation, laboratory results, imaging findings, diagnosis and treatment were summarized. Results: Among these 8 cases, aged from 9 hours to 14 years and 10 months. Fever was found in 4 cases, cough aggravation in 4, short of breath in 3, chest pain in 2, abdominal and back pain in one, hemoptysis in 2, cyanosis in 1, and edema of lower extremities in 2. Physical examination found decreased breath sound in 2 cases, phlegm rale in 3, and pleural friction rub in one. Pleural effusion was found in 5 cases by ultrasound. Plasma D-dimer increased in 6 cases (0.66-9.96 mg/L) and hypersensitive C-reactive protein elevated in 5 cases (10.78-78.00 mg/L). Chest enhanced CT showed pulmonary artery or venous filling defects, including pulmonary artery embolism in 7 cases and pulmonary vein embolism in one. The primary disease of these patients included Mycoplasma Pneumoniae pneumonia in 4 cases, nephritis in 2 and postoperative congenital heart disease in 2. Apart from one case who withdrew the treatment and was discharged, the other 7 patients received anticoagulant treatment had good outcome. Conclusions: For children with Mycoplasma pneumoniae pneumonia, immune disorders, long-term hormone therapy, cardiovascular invasive operation or other high-risk factors, PTE should be considered when fever, cough aggravation, short of breath, chest and back pain with pleural effusion are present. Chest enhanced CT scan should be performed as soon as possible, and anticoagulation should be started once the diagnosis is confirmed.


Assuntos
Pneumonia por Mycoplasma/complicações , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico , Adolescente , Dor no Peito/diagnóstico por imagem , Criança , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Masculino , Derrame Pleural , Pneumonia por Mycoplasma/diagnóstico , Embolia Pulmonar/complicações , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(4): e18881, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977894

RESUMO

INTRODUCTION: Nexplanon is a 4 cm rod-shaped barium sulphate coated contraceptive implant with a usual subdermal insertion in the inner non-dominant upper arm. Complications proper to subdermal contraceptive implants are unusual and principally localized and minor, comprising infection at the site of implantation, hematoma, abnormal scar development, or local nerve and blood vessel injuries. Infrequently, contraceptive implant migration can happen, though habitually not far from the site of insertion. Pulmonary embolization of the device is remarkably rare and can present with symptoms such as chest pain or dyspnea. PATIENT CONCERNS AND DIAGNOSIS: We report one of the rare cases of asymptomatic Nexplanon pulmonary embolism in a 26-year-old female. INTERVENTIONS AND OUTCOMES: An endovascular intervention successfully retrieved the device from the lateral segment right middle lobe pulmonary artery without any complications. CONCLUSION: Several cases of contraceptive implant migration into the pulmonary artery have been reported to this day. Preventing this life-threatening complication is challenging, and yet, no clear guidelines have been established.


Assuntos
/administração & dosagem , Desogestrel/administração & dosagem , Implantes de Medicamento/efeitos adversos , Migração de Corpo Estranho/cirurgia , Artéria Pulmonar/diagnóstico por imagem , Adulto , Angiografia por Tomografia Computadorizada/métodos , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , Ultrassonografia
4.
Tex Heart Inst J ; 46(3): 225-228, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708710

RESUMO

Anomalous origin of the right coronary artery from the pulmonary artery, a rare congenital cardiac defect, is typically not diagnosed during infancy. On the other hand, Turner syndrome is usually diagnosed early, and it is classically associated with bicuspid aortic valve and aortic coarctation. Individuals with Turner syndrome are also at increased risk for coronary artery anomalies. We present a case of anomalous right coronary artery from the pulmonary artery in a week-old neonate who also had Turner syndrome, patent ductus arteriosus, transverse aortic arch hypoplasia, and impaired ventricular function. Prostaglandin therapy through the ductus increased the patient's myocardial perfusion. Four months after corrective surgery, she was doing well. We discuss the reperfusion phenomenon in our patient's case, as well as other considerations in this combination of congenital defects.


Assuntos
Anormalidades Múltiplas , Aorta Torácica/anormalidades , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Síndrome de Turner/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Cateterismo Cardíaco , Angiografia por Tomografia Computadorizada , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Ecocardiografia , Feminino , Fluoroscopia , Humanos , Recém-Nascido , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia
5.
J Cardiothorac Surg ; 14(1): 196, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718656

RESUMO

BACKGROUND: Primary thrombosis of the pulmonary vasculatures without extra-pulmonary sources of embolism are uncommon. Here, we report 2 cases of thrombosis of the stump of the remnant pulmonary vasculatures after lung resection complicated by embolic events with review of the literature. CASE PRESENTATION: A 75-year-old female was consulted to evaluate cardiac source of embolism for acute cerebral infarction. The patient underwent left upper lobectomy because of lung cancer 2 years ago. Cardiovascular imaging revealed about 1.6 cm × 1.4 cm sized thrombus within the remnant stump of the left superior pulmonary vein. The patient was treated by anticoagulation with warfarin, because the patients refused surgical removal of thrombus. A 57-year-old female who had a history of right pneumonectomy 10 years ago presented with dyspnea. Cardiovascular imaging revealed 1.7 × 1.5 cm sized thrombus in the right pulmonary artery stump and small pulmonary embolism in the left lower segmental pulmonary artery. The patient was treated by long-term anticoagulation with warfarin, and the thrombus and pulmonary embolism were resolved. CONCLUSION: The present cases demonstrated that very late thrombosis of the remnant pulmonary vascular structures and subsequent fatal embolic complications can develope even several years later after lung resection. Therefore, the dead space of the remnant vascular structures should be minimized during lung resection surgery, and the developement of delayed thromboembolic complications associated with vascular stump thrombosis should be carefully monitored.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Embolia Pulmonar/etiologia , Veias Pulmonares/diagnóstico por imagem , Trombose Venosa/etiologia , Idoso , Infarto Encefálico/etiologia , Dispneia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Embolia Pulmonar/diagnóstico por imagem , Veias Pulmonares/cirurgia , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem
7.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(10): 755-759, 2019 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-31594109

RESUMO

Objective: To analyze the clinical characteristics of pulmonary embolism patients from different altitudes in plateau areas. Methods: A retrospective cross-sectional study was used to analyze the patients with acute pulmonary embolism diagnosed definitely by pulmonary angiography or pulmonary artery CT angiography admitted to Tibet Autonomous Region People's Hospital from August 2014 to December 2018. The subjects were divided into 3 groups according to the altitude of long-term residence before onset, i.e. low-altitude group (group 1, 2 700 m ≤ altitude ≤3 700 m, n=44), medium-altitude group (group 2, 3 700 m

Assuntos
Altitude , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Dor no Peito/epidemiologia , China/epidemiologia , Angiografia por Tomografia Computadorizada , Estudos Transversais , Dispneia/epidemiologia , Humanos , Hipóxia , Incidência , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos
8.
Medicine (Baltimore) ; 98(40): e17369, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577738

RESUMO

This study aimed to analyze the correlation between the efficiency coefficient of right ventricular-pulmonary artery coupling (ηvv) and the prognosis of patients with pulmonary arterial hypertension (PAH).A total of 64 patients who underwent right heart catheterization (RHC) were enrolled and divided into PAH and control groups depending on the RHC results. Pressure and volumetric methods were adopted to analyze the results of RHC and cardiac magnetic resonance imaging examination. The ηvv of patients in 2 groups were calculated, and the relationship between ηvv calculated by the 2 methods and the 2-year prognosis of patients with PAH was evaluated.The hemodynamic index and right ventricular-pulmonary artery coupling parameter of patients with PAH were significantly higher than those in the control group (P < .05). The right ventricular volume parameter in the PAH group was significantly different from that in the control group (P < .05). For patients with PAH, the end-systolic elastance/effective arterial elastance (Ees/Ea) calculated by the volumetric method was significantly related to the prognosis of patients (odds ratio = 0.192, 95% confidence interval: 0.042-0.868, P = .032). When Ees/Ea <0.67 was calculated by the volumetric method, the adverse prognosis of patients with PAH increased significantly (P < .05).The Ees/Ea calculated by the volumetric method may be better an independent factor for the prognosis of patients with PAH.


Assuntos
Hemodinâmica/fisiologia , Hipertensão Pulmonar/fisiopatologia , Artéria Pulmonar/fisiopatologia , Função Ventricular Direita/fisiologia , Adolescente , Adulto , Idoso , Cateterismo Cardíaco , Criança , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/fisiologia , Prognóstico , Artéria Pulmonar/diagnóstico por imagem , Volume Sistólico , Adulto Jovem
9.
Zhonghua Fu Chan Ke Za Zhi ; 54(10): 660-665, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31648441

RESUMO

Objective: To analyze the pregnancy outcomes of fetal tetralogy of Fallot and to explore its prenatal diagnosis and treatment procedures. Methods: The clinical data of 63 cases of fetal tetralogy of Fallot (62 cases were singleton and 1 case was one of twin) were collected retrospectively from November, 2013 to November, 2017 in Beijing Obstetrics and Gynecology Hospital. Results: (1) Totally, 63 cases out of 46 352 pregnancies were diagnosed fetal tetralogy of Fallot by fetal ultrasonic cardiogram with about 0.136%(63/46 352) occurrence rate, and the mean gestational age was (23±3) weeks. And 50 cases (79%, 50/63) terminated pregnancy by induced labour. (2) Totally, 57 cases (90%,57/63) accepted genetic diagnosis.Eight cases (13%, 8/63) existed chromosome abnormality including 21-trimosy in 6 cases, 18-trisomy in 1 case and 22q11.2 microdeletion syndrome in 1 case; and these 8 cases were determined before 28 gestational weeks. (3) And 13 cases (21%, 13/63) of no fetal genetic abnormality selected to continue pregnancy. Twelve cases underwent full term delivery (5 cases were cesarean section delivery and 7 cases were vaginal delivery). Twelve newborns underwent surgical radical operation on heart malformation and got recovery. One case underwent preterm cesarean section at 35 gestational weeks for one of twin, and the newborn with tetralogy of Fallot was dead. The other the newborns survived and were followed up for tetralogy of Fallot surgery from 1 month to 3 years old after birth and recovered. Conclusions: Fetal tetralogy of Fallot mainly is diagnosed by ultrasonic cardiogram in the second trimester. The gestational age of diagnosis may be as early as 15 gestational weeks. Fetal tetralogy of Fallot with no genetic abnormality could underwent radical heart malformation operation after birth. It is necessary to undergo genetic testing on fetal tetralogy of Fallot and prenatal multidisciplinary counseling as well.


Assuntos
Resultado da Gravidez , Diagnóstico Pré-Natal/métodos , Tetralogia de Fallot/diagnóstico por imagem , Ultrassonografia Pré-Natal , Aorta/diagnóstico por imagem , Aorta/patologia , Cesárea , Feminino , Feto , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Gravidez , Artéria Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Tetralogia de Fallot/diagnóstico
10.
Cancer Radiother ; 23(8): 926-929, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31611052

RESUMO

Stereotactic body radiation therapy is still controversial for inoperable patients with central lung lesion. We report the case of a 59-year-old woman with previous history of head and neck squamous cell carcinoma who was treated by lung stereotactic body irradiation for an inoperable lymph node in station 10R. One year after, a fibroscopy showed a necrosis of the right main bronchus mucosae and the CT showed a radio-induced aneurysm protruding into the right inferior lobular bronchus. The patient eventually died a few hours later with a massive haemoptysis. This case highlights the potential toxicity of central lung stereotactic body radiation therapy and raises the question of its legitimacy.


Assuntos
Aneurisma/etiologia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Irradiação Linfática/efeitos adversos , Artéria Pulmonar/efeitos da radiação , Radiocirurgia/efeitos adversos , Aneurisma/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/terapia , Fracionamento da Dose de Radiação , Feminino , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Neoplasias Pulmonares/patologia , Irradiação Linfática/métodos , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/terapia , Artéria Pulmonar/diagnóstico por imagem , Radiocirurgia/métodos
11.
Med. clín (Ed. impr.) ; 153(6): 232-238, sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-184028

RESUMO

Introducción y objetivo: La hipertensión pulmonar asocia peor pronóstico en insuficiencia cardiaca (IC). En este estudio buscamos identificar predictores pronósticos no invasivos en IC con y sin hipertensión pulmonar asociada, mediante resonancia magnética cardiaca y determinación de marcadores de estrés oxidativo y antiinflamatorios. Pacientes y métodos: Inclusión prospectiva de 70 pacientes ingresados por IC de comienzo, en los que se determinó la velocidad media de arteria pulmonar (vmAP) y la concentración sanguínea de TroloxTM (estatus antioxidante) e IL-10 (citocina antiinflamatoria). La muestra se dividió en dos grupos de acuerdo con el valor óptimo de vmAP para la predicción de sucesos calculados mediante curva ROC (vmAP=8cm/s), considerando los reingresos por IC y la mortalidad global como el suceso cardiovascular primario. Resultados: Tras una mediana de seguimiento de 290 días se produjeron 16 episodios. La vmAP ≤8cm/s predijo una mayor incidencia de episodios en pacientes con función ventricular derecha conservada, no así en aquellos con disfunción ventricular derecha; análisis de supervivencia con curva de Kaplan-Meier, log rank 6,01, p=0,014. Los pacientes con vmAP ≤ 8 cm/s presentaron niveles plasmáticos menores de Trolox(TM). Los pacientes con mayor concentración de IL-10 presentaron menor incidencia de episodios en el seguimiento. Conclusión: La vmAP es un indicador pronóstico no invasivo precoz en IC con y sin hipertensión pulmonar asociada, previo al desarrollo de disfunción ventricular derecha. La menor concentración de Trolox(TM) en pacientes con vmAP ≤ 8 cm/s refleja un mayor nivel de estrés oxidativo en pacientes de peor pronóstico, mientras que la mayor expresión de IL-10 en pacientes libres de eventos podría guardar relación con su efecto antiinflamatorio y potencialmente protector en IC


Background and objective: To identify early, non-invasive prognostic indicators in heart failure (HF), with and without associated pulmonary hypertension, by means of cardiac magnetic resonance, and oxidative stress and anti-inflammatory biomarkers such as TroloxTM (antioxidant status) and IL-10 (anti-inflammatory cytokine). Patients and methods: We prospectively included 70 patients admitted for new-onset HF. During index admission, mean velocity of the pulmonary artery (mvPA) was measured, and blood TroloxTM and IL-10 determined. The study sample was divided in two groups according to the optimal cut-off value for event prediction calculated by the ROC curve (mvPA=8cm/s), considering HF-readmission and all-cause mortality as the primary combined event. Results: During a median follow-up of 290 days, 16 events occurred. In patients with preserved right ventricular (RV) function, mvPA ≤8cm/s was associated with a higher incidence of events during follow-up, Kaplan-Meier survival analysis (log rank 6.01, p=.014). MvPA did not add prognostic value when RV dysfunction was already established. TroloxTM concentration was lower in patients with mvPA ≤8cm/s. Higher IL-10 expression was associated with a lower incidence of cardiovascular events during follow-up. Conclusion: In HF patients, mvPA ≤8cm/s predicts a higher rate of cardiovascular events. Specifically, mvPA identifies a higher risk population among patients with preserved RV function, thus confirming its role as an early prognostic indicator. Lower TroloxTM concentration in the worse prognosis group concurs with previous studies on oxidative stress in pulmonary hypertension. Higher IL-10 concentration among patients free of cardiovascular events could be a reflection of its anti-inflammatory and thus protective role in HF


Assuntos
Humanos , Insuficiência Cardíaca/diagnóstico por imagem , Prognóstico , Velocidade do Fluxo Sanguíneo , Artéria Pulmonar/diagnóstico por imagem , Estresse Oxidativo , Anti-Inflamatórios , Estudos Prospectivos , Curva ROC , Estimativa de Kaplan-Meier , Autofagia , Fibrilação Atrial , Taxa de Filtração Glomerular , Cateterismo Cardíaco/métodos , Modelos Logísticos , Análise Multivariada
12.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401571

RESUMO

A woman with asymptomatic pulmonary arteriovenous malformation (PAVM) discovered incidentally on admission developed recurrent generalised seizures. Immediately after, the PAVM demonstrated marked expansion, and was safely resected. Congenital PAVMs (associated with hereditary haemorrhagic telangiectasia or sporadic) are considered stable lesions that exhibit very slow growth if at all. A review of the literature reveals all circumstances of accelerated growth of PAVM (puberty, pregnancy, postpartum, pulmonary hypertension) and suggests a novel mechanism of seizure-associated expansion. This is important because the size and rapid growth of PAVMs correlate with the potential for rupture and other ominous complications such as right to left shunt and paradoxical emboli. The new seizures-PAVM progression association mandates recognition since the risk of seizures in patients with PAVM is substantial. Our observations strongly suggest the need to monitor PAVM in patients with or without haemorrhagic telangiectasis by repeated imaging after generalised seizures to evaluate potential expansion and risk.


Assuntos
Fístula Arteriovenosa/complicações , Pulmão/patologia , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Convulsões/etiologia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pulmão/cirurgia , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Tomografia Computadorizada por Raios X
13.
BMC Med Imaging ; 19(1): 65, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412797

RESUMO

BACKGROUND: Computed tomography pulmonary angiography (CTPA) is the gold standard for the diagnosis of pulmonary embolism (PE). However, contrast is contraindicated in some patients. The purpose of this study was to determine the diagnostic accuracy of unenhanced multidetector CT (MDCT) for diagnosis of central PE using CTPA as the gold standard. METHODS: The records of patients with suspected PE seen between 2010 and 2013 were retrospectively reviewed. Inclusion criteria were an acute, central PE confirmed by CTPA and non-enhanced MDCT before contrast injection. Patients with a PE ruled out by CTPA served as a control group. MDCT findings studied were high-attenuation emboli in pulmonary artery (PA), main PA dilatation > 33.2 mm, and peripheral wedge-shaped consolidation. Receiver operating characteristic (ROC) analysis was used to determine the sensitivity and specificity of unenhanced MDCT to detect PE. Wells score of all patients were calculated using data extracted from medical records prior to imaging analysis. RESULTS: Thirty-two patients with a PE confirmed by CTPA and 32 with a PE ruled out by CTPA were included. Among the three main MDCT findings, high-attenuation emboli in the PA showed best diagnostic performance (Sensitivity 72.9%; Specificity 100%), followed by main PA dilatation > 33.2 mm (sensitivity 46.9%; specificity 90.6%), and peripheral wedge-shaped consolidation (sensitivity 43.8%; specificity 78.1%). Given any one or more positive findings on unenhanced MDCT, the sensitivity was 96.9% and specificity was 71.9% for a diagnosis of PE in patients. The area under the curve (AUC) of a composite measure of unenhanced MDCT findings (0.909) was significantly higher than that of the Wells score (0.688), indicating unenhanced MDCT was reliable for detecting PE than Wells score. CONCLUSIONS: Unenhanced MDCT is an alternative for the diagnosis of acute central PE when CTPA is not available.


Assuntos
Tomografia Computadorizada Multidetectores/métodos , Artéria Pulmonar/patologia , Embolia Pulmonar/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Angiografia por Tomografia Computadorizada , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/patologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
14.
Heart Surg Forum ; 22(4): E308-E309, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31398098

RESUMO

Anomalies of the coronary arteries -- especially their abnormal origin from the pulmonary artery (ARCAPA) trunk -- are among the least common. They're also the most dangerous of congenital heart defects with an incidence of 0.002% in the general population [Williams 2006]. The diagnosis exceedingly is difficult because anatomical abnormalities of the coronary arteries are subtle. We present a case of an anomalous origin of the right coronary artery.


Assuntos
Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Angiografia por Tomografia Computadorizada , Circulação Coronária , Ecocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem
15.
J Vet Cardiol ; 24: 85-94, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31405559

RESUMO

INTRODUCTION: Non-invasive diagnosis of pulmonary hypertension (PH) relies on estimation of pulmonary arterial pressure (PAP) via Doppler echocardiographic measurement of tricuspid regurgitation pressure gradient (TRPG). The pulmonary vein-to-right pulmonary artery ratio (PV/PA) recently has been described for the detection of pulmonary venous congestion. Whether this variable could be used to detect the presence of precapillary PH is unknown. The objective of the present study was to investigate the diagnostic value of PV/PA for prediction of TRPG, as a surrogate of PAP, in dogs with PH of precapillary origin. ANIMALS: Sixty-seven client-owned dogs were included in the study. METHODS: This was a retrospective study. Dogs with a measurable TRPG were included and classified into group 1 (TRPG < 30 mmHg), group 2 (TRPG 30-49 mmHg), group 3 (TRPG 50-80 mmHg), or group 4 (TRPG > 80 mmHg). The PV/PA, acceleration time-to-ejection time ratio of pulmonary artery flow, main pulmonary artery diameter-to-aortic diameter ratio, and right pulmonary artery distensibility index were measured retrospectively from cineloops in each dog. RESULTS: The PV/PA measured by both two-dimensional (2D) and time-motion mode(MM) echocardiography decreased proportionally with PH severity. Using regression analysis, PV/PA (2D) was identified as the strongest predictor for TRPG (R2 = 0.70, p < 0.0001) among other variables studied, with a good diagnostic accuracy (area under the curve = 0.94) for moderate PH (TRPG > 50 mmHg) using a cutoff value of < 0.70 (sensitivity = 96%, specificity = 82%). CONCLUSIONS: Results of the present study suggest that PV/PA can be useful as an additional, non-invasive, and indirect variable to identify precapillary PH in dogs.


Assuntos
Doenças do Cão/diagnóstico , Hipertensão Pulmonar/diagnóstico , Artéria Pulmonar/diagnóstico por imagem , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Ecocardiografia Doppler/veterinária , Feminino , Hipertensão Pulmonar/diagnóstico por imagem , Masculino , Sensibilidade e Especificidade
16.
Chin Med J (Engl) ; 132(16): 1903-1908, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31369430

RESUMO

BACKGROUND: Cross-sectional area (CSA) for small pulmonary vessels is considered a parameter of pulmonary vessel alterations in patients with chronic obstructive pulmonary disease. This study was to evaluate the correlation of CSA with airflow obstruction parameters in asthma. Furthermore, we aimed to measure the difference in vascular alteration between asthma phenotypes and evaluate its relation with cytokine levels. METHODS: We consecutively enrolled 20 adult asthmatic patients (13 women: age range, 26-80 years) and 20 healthy controls (8 women: age range, 23-61 years) from Peking University Third Hospital. Total CSA <5 mm (CSA<5) was measured with 64-slice spiral computed tomography, and the percentage CSA <5 for the lung area (%CSA<5) was calculated. Data were corrected for body surface area to obtain sixth-generation airway luminal diameter (LDcor), luminal area (Aicor), and airway wall thickness, and airway wall area percentage (WA%) was calculated. Enzyme-linked immunosorbent assay was used to detect the expression of leptin, total immunoglobulin E, periostin, and transforming growth factor ß1 in serum and matrix metalloproteinase 9 in induced sputum supernatant of asthmatic patients. The differences in %CSA<5 between subgroups were assessed by independent samples Student's t test, and Spearman correlation analysis was used to analyze the correlation of %CSA<5 with clinical indexes and inflammatory cytokine levels. RESULTS: Patients with asthma and controls did not differ in %CSA<5. In asthma patients, %CSA<5 was lower with initial onset age ≤12 years old, airflow restriction and uncontrolled Global Initiative for Asthma classification (all P < 0.05). Moreover, it was positively correlated with forced vital capacity ratio in 1 s (FEV1)/forced expiratory volume ratio, FEV1%, LDcor, Aicor, and serum leptin level (all P < 0.05) and negatively with total lung WA% (P = 0.007). CONCLUSIONS: %CSA<5 of pulmonary small vessels was well correlated with airflow limitation indexes and sixth-generation airway parameters. It has certain significance in predicting the clinical control of asthma.


Assuntos
Asma/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Veias Pulmonares/diagnóstico por imagem , Testes de Função Respiratória , Adulto Jovem
17.
Zhonghua Er Ke Za Zhi ; 57(8): 620-624, 2019 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-31352748

RESUMO

Objective: To improve the awareness of methylmalonic acidemia and hyperhomocysteinemia with diffuse lung disease as an initial or main presentation. Methods: A retrospective analysis of the clinical manifestations, radiological features, laboratory tests, genetic variations, treatments and prognoses was conducted in six children presented with diffuse lung disease and finally diagnosed with methylmalonic acidemia and hyperhomocysteinemia in Ward 2 of Department of Respiratory Diseases, Beijing Children's Hospital, from August 2017 to November 2018. Results: Six children were included in this study. Two children were male and four were female. The average age of onset was 28 months. The mean age at diagnosis was 34 months. The average interval from onset to diagnosis was 6 months. Four children who underwent genetic tests were found to have variants of gene MMACHC and diagnosed with CblC type. All children had respiratory symptoms and signs as initial or main presentation, which were tachypnea (5 cases), exercise intolerance (5 cases), cough (4 cases), cyanosis (4 cases), clubbing (4 cases), dyspnea (3 cases) and retractions (3 cases). Pulmonary arterial hypertension was found in all six children. Pericardial effusion (4 cases), kidney involvement (3 cases), nervous system involvement (3 cases), gastrointestinal system involvement (3 cases) and anemia (2 cases) also coexisted. The high resolution computed tomography (HRCT) features included dilated pulmonary artery (6 cases), ground-glass opacities (4 cases), diffuse poorly defined ground-glass centrilobular nodules (3 cases), pleural effusion (3 cases), thickening of interlobular septum (2 cases), etc. All children had an elevated concentration of methylmalonic acid in urine and homocysteine in plasma. Genetic tests were performed in four patients, and MMACHC genetic mutations were found in all of them. Clinical manifestations, HRCT features and pulmonary arterial hypertension turned better in five children after treatment. One patient who was not regularly followed-up died. Conclusions: Pulmonary involvement including diffuse lung disease and pulmonary arterial hypertension could coexist with methylmalonic acidemia and hyperhomocysteinemia, which may have respiratory symptoms and signs as the initial or main presentation. Characteristic HRCT features were found in some patients. Plasma homocysteine test is a quick method for screening the disease in children with diffuse lung disease and (or) pulmonary arterial hypertension. Both diffuse lung disease and pulmonary arterial hypertension may turn better after treatment.


Assuntos
Erros Inatos do Metabolismo dos Aminoácidos/diagnóstico , Hiper-Homocisteinemia/diagnóstico , Pneumopatias/etiologia , Pulmão/fisiopatologia , Artéria Pulmonar/diagnóstico por imagem , Idade de Início , Erros Inatos do Metabolismo dos Aminoácidos/urina , Proteínas de Transporte , Criança , Pré-Escolar , Feminino , Humanos , Hiper-Homocisteinemia/sangue , Lactente , Masculino , Oxirredutases , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
18.
Pediatr Cardiol ; 40(6): 1304-1313, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31338561

RESUMO

This study aimed to evaluate fetal echocardiographic parameters associated with neonatal intervention and single-ventricle palliation (SVP) in fetuses with suspected left-sided cardiac lesions. Initial fetal echocardiograms (1/2002-1/2017) were interpreted by the contemporary fetal cardiologist as coarctation of the aorta (COA), left heart hypoplasia (LHH), hypoplastic left heart syndrome (HLHS), mitral valve hypoplasia (MVH) ± stenosis, and aortic valve hypoplasia ± stenosis (AS). The cohort comprised 68 fetuses with suspected left-sided cardiac lesions (COA n = 15, LHH n = 9, HLHS n = 39, MVH n = 1, and AS n = 4). Smaller left ventricular (LV) length Z score, aortic valve Z score, ascending aorta Z score, and aorta/pulmonary artery ratio; left-to-right shunting at the foramen ovale; and retrograde flow in the aortic arch were associated with the need for neonatal intervention (p = 0.005-0.04). Smaller mitral valve (MV) Z score, LV length Z score, aortic valve Z score, ascending aorta Z score, aorta/pulmonary artery ratio, and LV ejection fraction, as well as higher tricuspid valve-to-MV (TV/MV) ratio, right ventricular-to-LV (RV/LV) length ratio, left-to-right shunting at the foramen ovale, abnormal pulmonary vein Doppler, absence of prograde aortic flow, and retrograde flow in the aortic arch were associated with SVP (p < 0.001-0.008). The strongest independent variable associated with SVP was RV/LV length ratio (stepwise logistical regression, p = 0.03); an RV/LV length ratio > 1.28 was associated with SVP with a sensitivity of 76% and specificity of 96% (AUC 0.90, p < 0.001). A fetal RV/LV length ratio of > 1.28 may be a useful threshold for identifying fetuses requiring SVP.


Assuntos
Ecocardiografia/métodos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Diagnóstico Pré-Natal , Adulto , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Valva Mitral/anormalidades , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Gravidez , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
19.
Am J Vet Res ; 80(8): 756-763, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31339762

RESUMO

OBJECTIVE: To evaluate effects of airway pressure on contrast enhancement and diameter of the pulmonary artery and determine the optimal airway pressure for pulmonary CT angiography in dogs. ANIMALS: 8 healthy Beagles. PROCEDURES: Thoracic CT was performed at end-expiration (0 cm H2O) and 2 positive-pressure end-inspirations (10 and 20 cm H2O). Attenuation curves of enhancement for the sinus of the pulmonary trunk artery were obtained by use of a bolus technique. Contrast medium (300 mg of I/kg) was administered IV, and CT imaging began at the time of peak enhancement. At each pressure, time to peak enhancement, ratio of blood flow from the caudal vena cava to the right side of the heart (KCdVC), and enhancement characteristics and diameter changes of the pulmonary artery were evaluated. RESULTS: All dogs had a significant delay for time to peak enhancement in the sinus of the pulmonary trunk artery as airway pressure increased. The KCdVC progressively increased as airway pressure increased, and there was low contrast enhancement and increased pulmonary artery filling defects at 20 cm H2O. All pulmonary arteries had marked increases in diameter as pressure increased. Arterial distensibility in the gravity-dependent cranial lung region was greater than that in the gravity-independent caudal lung region at the 2 positive-pressure end-inspirations. CONCLUSIONS AND CLINICAL RELEVANCE: Airway pressure affected time to peak enhancement, KCdVC, contrast enhancement, and pulmonary artery diameter. Results suggested that 10 cm H2O could be an optimal pressure for evaluation of the pulmonary artery of dogs by use of CT angiography. (Am J Vet Res 2019;80;756-763).


Assuntos
Angiografia por Tomografia Computadorizada/veterinária , Cães/fisiologia , Artéria Pulmonar/diagnóstico por imagem , Fenômenos Fisiológicos Respiratórios , Resistência das Vias Respiratórias , Animais , Meios de Contraste , Cães/anatomia & histologia , Feminino , Hemodinâmica , Pulmão , Masculino , Respiração com Pressão Positiva , Veia Cava Inferior
20.
Biomed Res Int ; 2019: 4919416, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31321237

RESUMO

Purpose: Imaging artifacts are frequently encountered when performing clinical echocardiography. Based on our review of the literature, two-dimensional linear artifacts are mainly reported in the ascending aorta in patients with suspected aortic dissections. However, pulmonary artery artifacts that mimic pulmonary artery dissection have not been discussed. We herein report our experience with children and adults with preexisting heart conditions and pulmonary artery imaging artifacts. Methods: The study population comprised 10 patients with heart disease who were treated at our hospital from March 2015 to September 2017. Nine patients were children with congenital heart disease, mainly patent ductus arteriosus (n = 8), and one patient was an adult with pulmonary artery hypertension. Transthoracic echocardiography was performed in all patients. Results: We confirmed the diagnosis in six patients during a surgical operation for other indications and in four patients by computed tomographic pulmonary angiography. The most common pulmonary imaging artifact was observed from the left high parasternal view (9/10, 90%). Most of the artifacts were diagonally oriented (8/10, 80%), and a few were horizontally oriented. Half of the artifacts were located in the main pulmonary arteries with mild pulmonary artery dilatation. Pulmonary hypertension was seen only in the adult patient. The thymus gland was clearly seen in young patients. Conclusion: Pulmonary artery imaging artifacts in patients with preexisting heart disease during echocardiographic examination can mimic pulmonary artery dissection. Understanding the types and origins of these ultrasound artifacts is important to avoid a false-positive diagnosis.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Estenose de Artéria Pulmonar/diagnóstico por imagem , Adolescente , Adulto , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/fisiopatologia , Artefatos , Criança , Pré-Escolar , Ecocardiografia/métodos , Feminino , Cardiopatias/diagnóstico , Cardiopatias/fisiopatologia , Cardiopatias/cirurgia , Humanos , Lactente , Masculino , Estenose de Artéria Pulmonar/diagnóstico , Estenose de Artéria Pulmonar/fisiopatologia , Ultrassonografia/efeitos adversos , Ultrassonografia/métodos , Adulto Jovem
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