Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.034
Filtrar
1.
BMJ Case Rep ; 14(1)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419752

RESUMO

Hereditary haemorrhagic telangiectasia (HHT) also known as Osler-Weber-Rendu syndrome is an autosomal dominant disorder affecting 1 in 8000 individuals. The eponym recognises the 19th-century physicians William Osler, Henri Jules Louis Marie Rendu and Frederick Parkes Weber who each independently described the disease. It is characterised by epistaxis, telangiectasia and visceral arteriovenous malformations. Individuals with HHT have been found to have abnormal plasma concentrations of transforming growth factor beta and vascular endothelial growth factor secondary to mutations in ENG, ACVRL1 and MADH4. Pulmonary artery malformations (PAVMs) are abnormal communications between pulmonary arteries and veins and are found in up to 50% of individuals with HHT. The clinical features suggestive of PAVMs are stigmata of right to left shunting such as dyspnoea, hypoxaemia, cyanosis, cerebral embolism and unexplained haemoptysis or haemothorax. The authors present the case of a 33-year-old woman presenting with progressive dyspnoea during the COVID-19 pandemic. She had a typical presentation of HHT with recurrent epistaxis, telangiectasia and pulmonary arteriovenous malformations. Although rare, PAVM should be considered in individuals presenting to the emergency department with dyspnoea and hypoxaemia. Delayed diagnosis can result in fatal embolic and haemorrhagic complications.


Assuntos
Malformações Arteriovenosas/diagnóstico , Dispneia/fisiopatologia , Epistaxe/fisiopatologia , Hipóxia/fisiopatologia , Telangiectasia Hemorrágica Hereditária/diagnóstico , Receptores de Activinas Tipo II/genética , Adulto , Antitireóideos/uso terapêutico , Malformações Arteriovenosas/fisiopatologia , Gasometria , Carbimazol/uso terapêutico , Diagnóstico Diferencial , Feminino , Doença de Graves/complicações , Doença de Graves/tratamento farmacológico , Humanos , Transtornos de Enxaqueca/complicações , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/fisiopatologia , Tomografia Computadorizada por Raios X
2.
Eur J Radiol ; 134: 109442, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33321459

RESUMO

PURPOSE: The vascular enlargement (VE) pattern differs from previously described imaging patterns for pneumonia. This study aimed to investigate the incidence, computed tomography (CT) characteristics, and diagnostic value of the VE pattern in coronavirus disease 2019 (COVID-19). METHOD: The CT data of 106 patients with COVID-19 from January 19 to February 29, 2020, and 52 patients with influenza virus pneumonia (IVP) from January 2018 to February 2020 were retrospectively collected. The incidences of the VE pattern between the two groups were compared. The CT manifestations of COVID-19 were analyzed with a particular focus on the VE pattern's specific CT signs, dynamic changes, and relationships with lesion size and disease severity. RESULTS: Peripheral and multilobar ground-glass opacities (GGOs) or mixed GGOs with various sizes and morphologies were typical features of COVID-19 on initial CT. The VE pattern was more common in COVID-19 (88/106, 83.02 %) than in IVP (10/52, 19.23 %) on initial CT (P < 0.001). Three special VE-pattern-specific CT signs, including central vascular sign, ginkgo leaf sign, and comb sign, were identified. Four types of dynamic changes in the VE pattern were observed on initial and follow-up CT, which were closely associated with the evolution of lesions and the time interval from the onset of symptoms to initial CT scan. The VE pattern in COVID-19 was more commonly seen in larger lesions and patients with severe-critical type (all P < 0.001). CONCLUSIONS: The VE pattern is a valuable CT sign for differentiating COVID-19 from IVP, which correlates with more extensive or serious disease. A good understanding of the CT characteristics of the VE pattern may contribute to the early and accurate diagnosis of COVID-19 and prediction of the evolution of lesions.


Assuntos
/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Artéria Pulmonar/patologia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/patologia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Diagnóstico Diferencial , Feminino , Humanos , Influenza Humana/diagnóstico por imagem , Influenza Humana/patologia , Pulmão/irrigação sanguínea , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pneumonia/patologia , Artéria Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Adulto Jovem
3.
Rozhl Chir ; 99(10): 467-471, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33242965

RESUMO

Pulmonary arteriovenous malformation (PAVM) is formed by abnormal connections between pulmonary arteries and veins that bypass the pulmonary capillaries and transport deoxygenated blood through pulmonary veins to the left heart. This causes insufficient oxygenation of blood in the lungs. This condition remains symptomless for a long period of time. The most common symptoms include shortness of breath on exertion, nosebleeds, increased fatigue and a gradual development of cyanosis. Paradoxical embolism in the brain is a serious complication; it can present with a stroke or a brain abscess. Treatment of the disease consists of embolization of the pathological vascular connections, surgical resection of the affected pulmonary parenchyma and management of concomitant manifestations of the disease. PAVM in most common cases arises as a result of an autosomal dominant hereditary disorder referred to as hereditary hemorrhagic telangiectasia.  Case report: In our communication, we document the diagnostic and therapeutic management in a young patient diagnosed with PAVM after falling off his bicycle. Based on comprehensive assessments, AV malformations with a 40% shunt of the pulmonary circulation were detected. An angiographic procedure was not an appropriate option considering the type and extent of the condition. Therefore, video-assisted thoracic resection of the affected pulmonary lobe was indicated. Conclusion: PAVM is a rare finding. PAVM should be ruled out in all patients with hereditary hemorrhagic telangiectasia (HHT) signs in the oral cavity. Contrast sonography of the heart and contract CT of the chest are the methods of choice for the diagnosis. Conservative or pharmacological treat-ment fails to improve the patients status.  The condition is usually managed by embolization. Cases where PAVM is rather extensive or diffuse, where endovascular management would be inappropriate, can be well managed using endoscopic resection adequate to the extent of the condition.


Assuntos
Malformações Arteriovenosas , Veias Pulmonares , Telangiectasia Hemorrágica Hereditária , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/cirurgia , Humanos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/cirurgia , Cirurgia Torácica Vídeoassistida
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1207-1210, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018204

RESUMO

Accurate segmentation of pulmonary vein (PV) and left atrium (LA) is essential for the preoperative evaluation and planning of total anomalous pulmonary venous connection (TAPVC), which is a rare but mortal congenital heart disease of children. However, manual segmentation is time-consuming and insipid. To free radiologists from the repetitive work, we propose an automatic deep learning method to segment PV and LA from Low-Dose CT images. In the method, attention mechanism is incorporated into the widely used V-Net and a novel grouped attention module is applied to enforce the segmentation performance of the V-Net. We evaluate our method on 68 3D Low-Dose CT images scanned from patients with TAPVC. The experiment result shows that our method outperforms the popular 3D-UNet and V-Net, with mean dice similarity coefficient (DSC) of 0.795 and 0.834 for the PV and LA respectively.Clinical relevance-We proposed a CNNs-based method for the automatic segmentation of PV and LA with good accuracy, which can be used for the preoperative evaluation and planning of TAPVC. Our method can improve the efficiency and reduce the workloads of radiologists (400 milliseconds vs. 2-3 hours per-case).


Assuntos
Veias Pulmonares , Síndrome de Cimitarra , Atenção , Criança , Átrios do Coração/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Veias Pulmonares/diagnóstico por imagem
5.
J Cardiothorac Surg ; 15(1): 290, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008483

RESUMO

BACKGROUND: Pulmonary arteriovenous malformations are uncommon conditions of abnormal communications between pulmonary arteries and veins, which are most commonly congenital in nature. Although such condition is not extremely rare, it is a challenge to the differential diagnosis of pulmonary problems such as hypoxemia and pulmonary lesions. CASE PRESENTATION: We report a meaningful case of a 23-year-old male presented with elevated hemoglobin (23.0 g/dl) on admission. Physical examination revealed cyanosis, digital clubbing and low oxygen saturation on room air. The patient was initially diagnosed as polycythemia vera while the subsequent result of bone marrow aspiration was negative. During further assessment, pulmonary arteriovenous malformations were detected by CT pulmonary angiography. Lobectomy was successfully performed with significant increase in oxygen saturation from 86 to 98%. The hemoglobin decreased to almost normal level of 14.9 g/dl 3 months after surgery and the patient had been followed up for nearly 5 years. CONCLUSIONS: Pulmonary arteriovenous malformations should be suspected in patients with central cyanosis, digital clubbing, polycythemia, pulmonary lesion and without cardiac malformations. Embolization or surgery is strongly recommended to reduce the risks caused by pulmonary arteriovenous malformations.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Veias Pulmonares/anormalidades , Tuberculose/complicações , Fístula Arteriovenosa/complicações , Angiografia por Tomografia Computadorizada , Progressão da Doença , Humanos , Masculino , Pneumonectomia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Adulto Jovem
6.
Artigo em Russo | MEDLINE | ID: mdl-33081455

RESUMO

Paradoxical embolism is one of the mechanisms of ischemic stroke in patients younger than 45 years of age, due to opening between the right and left chambers of the heart through a patent foramen ovale, an atrial or ventricular septal defect, pulmonary arteriovenous malformations (PAVMs), etc. The PAVMs are structurally abnormal vessels that provide direct capillary-free communication between the pulmonary and systemic circulations, and hence an anatomic "right-to-left" shunt. Most pulmonary malformations are congenital and associated with hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease). This publication highlights the issues of pathogenesis, clinical presentation, diagnosis and treatment of this pathology, and also describes a clinical case in which multiple PAVMs caused repeated ischemic strokes.


Assuntos
Fístula Arteriovenosa , Embolia Paradoxal , Veias Pulmonares , Acidente Vascular Cerebral , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/etiologia , Humanos , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia
7.
Zhonghua Er Ke Za Zhi ; 58(8): 674-678, 2020 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-32842389

RESUMO

Objective: To analyze the clinical features of 2 children with hereditary hemorrhagic telangiectasia (HHT) and review relevant literature. Methods: The clinical data of 2 children with HHT who were admitted to Beijing Children's Hospital, Capital Medical University from February 2017 to June 2018 were retrospectively analyzed. Meanwhile, the relevant papers published before December 2019 in Wanfang and Pubmed database were searched with the key words of "hereditary hemorrhagic telangiectasia" in Chinese and English, and reviewed. Results: The first case was an 11-year-old boy, presented with fever and cough for 6 days. His past history revealed 3 times of left pneumonia and mild epistaxis. Ultrasound of the chest soft tissue found hemangioma and vascular malformation. Enhanced CT with vascular reconstruction suggested pulmonary arteriovenous malformation and multiple arteriovenous fistulas in the liver. After being treated with interventional pulmonary arteriovenous fistula embolization, his condition improved. The second case was a 12-year-old girl, presented with iron deficiency anemia during the past 3 years. Endoscopic resection of polyps had been performed before due to multiple polyps in the colon. High-resolution lung CT revealed multiple ground-glass nodules in bilateral lungs. Ultrasound of the digestive tract suggested small intestine polyps and secondary chronic loose intussusception. After admission, small bowel intussusception reduction was performed, and the polyps were ligated. Her whole exon gene testing suggested SMAD4 heterozygous variation. In the large number of reported cases, HHT1 and HHT2 are the main type. Conclusions: Children with HHT may present with anemia and repeated intestinal polyps. It is worth noting that visceral arteriovenous malformations, such as pulmonary arteriovenous malformations, which is easily misdiagnosed as recurrent pneumonia, can also occur in children with HHT. Enhanced CT with vascular reconstruction can help find pulmonary arteriovenous malformation, and timely genetic test can confirm the diagnosis.


Assuntos
Fístula Arteriovenosa/complicações , Malformações Arteriovenosas/diagnóstico , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/diagnóstico , Fístula Arteriovenosa/cirurgia , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/etiologia , Criança , Tosse/etiologia , Feminino , Febre/etiologia , Humanos , Fígado/diagnóstico por imagem , Masculino , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Estudos Retrospectivos , Telangiectasia Hemorrágica Hereditária/genética , Tomógrafos Computadorizados
9.
Circ Arrhythm Electrophysiol ; 13(7): e008213, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32536204

RESUMO

BACKGROUND: Pulmonary vein isolation (PVI) is an effective treatment strategy for patients with atrial fibrillation (AF), but many experience AF recurrence and require repeat ablation procedures. The goal of this study was to develop and evaluate a methodology that combines machine learning (ML) and personalized computational modeling to predict, before PVI, which patients are most likely to experience AF recurrence after PVI. METHODS: This single-center retrospective proof-of-concept study included 32 patients with documented paroxysmal AF who underwent PVI and had preprocedural late gadolinium enhanced magnetic resonance imaging. For each patient, a personalized computational model of the left atrium simulated AF induction via rapid pacing. Features were derived from pre-PVI late gadolinium enhanced magnetic resonance images and from results of simulations of AF induction. The most predictive features were used as input to a quadratic discriminant analysis ML classifier, which was trained, optimized, and evaluated with 10-fold nested cross-validation to predict the probability of AF recurrence post-PVI. RESULTS: In our cohort, the ML classifier predicted probability of AF recurrence with an average validation sensitivity and specificity of 82% and 89%, respectively, and a validation area under the curve of 0.82. Dissecting the relative contributions of simulations of AF induction and raw images to the predictive capability of the ML classifier, we found that when only features from simulations of AF induction were used to train the ML classifier, its performance remained similar (validation area under the curve, 0.81). However, when only features extracted from raw images were used for training, the validation area under the curve significantly decreased (0.47). CONCLUSIONS: ML and personalized computational modeling can be used together to accurately predict, using only pre-PVI late gadolinium enhanced magnetic resonance imaging scans as input, whether a patient is likely to experience AF recurrence following PVI, even when the patient cohort is small.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Diagnóstico por Computador , Aprendizado de Máquina , Imagem por Ressonância Magnética , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Veias Pulmonares/cirurgia , Potenciais de Ação , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Meios de Contraste/administração & dosagem , Feminino , Frequência Cardíaca , Humanos , Masculino , Meglumina/administração & dosagem , Meglumina/análogos & derivados , Pessoa de Meia-Idade , Compostos Organometálicos/administração & dosagem , Valor Preditivo dos Testes , Estudo de Prova de Conceito , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Recidiva , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
11.
J Card Surg ; 35(7): 1653-1656, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32353904

RESUMO

BACKGROUND AND AIM: Atrial septal defects with anomalous venous connections are commonly repaired via sternotomy, requiring careful baffle reconstruction to redirect pulmonary venous return and ensure a durable result. The cosmetically appealing periareolar incision may provide an esthetically superior alternative to the anterolateral minithoracotomy incision used in minimally invasive cardiac surgery. METHODS: We describe a patient with a sinus venosus atrial septal defect and partial anomalous pulmonary venous connection who underwent successful minimally invasive, endoscopic repair with apical vein translocation and autologous pericardial baffle reconstruction through a periareolar approach. RESULTS: Post-operative echocardiography demonstrated excellent results with no residual shunt and a widely patent baffle and preserved biventricular function. At 1-year post-op, our patient has had a greatly improved quality of life and an excellent cosmetic result with normal nipple-areolar sensation. CONCLUSIONS: We believe that periareolar approaches should be considered for all adult patients with simple and complex atrial septal defects.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/métodos , Endoscopia/métodos , Comunicação Interatrial/cirurgia , Veias Pulmonares/anormalidades , Veias Pulmonares/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Ecocardiografia , Feminino , Comunicação Interatrial/diagnóstico por imagem , Humanos , Veias Pulmonares/diagnóstico por imagem , Qualidade de Vida , Esternotomia/métodos , Resultado do Tratamento
12.
Clin Imaging ; 66: 23-25, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32442856

RESUMO

A 50-year-old female with a 20-year history of multifocal pulmonary benign metastasizing leiomyoma (BML), and asthma presented with subacute worsening of chronic dyspnea. A contrast-enhanced computerized tomography of the chest showed a single 1.4 × 1.5-cm contrast-enhancing mass in the right lower lobe among numerous non-enhancing bilateral pulmonary BML lesions. Pulmonary angiogram was not performed at that time due to clinical improvement. Four years later, the patient presented with refractory subacute worsening of her chronic dyspnea and was referred for embolization of the pulmonary arteriovenous malformation (PAVM). Two feeder arteries to the PAVM were embolized; each with a 6-mm Amplatzer-IV vascular plug and a 4-mm Nester coil. Follow-up angiograms demonstrated no flow through the PAVM. The patient's dyspnea resolved and she remained asymptomatic at one-year follow-up.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Malformações Arteriovenosas/diagnóstico por imagem , Leiomioma/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Angiografia , Malformações Arteriovenosas/terapia , Embolização Terapêutica/métodos , Feminino , Humanos , Leiomioma/terapia , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X
13.
Int J Cardiovasc Imaging ; 36(9): 1699-1709, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32440796

RESUMO

Measurement of pulmonary venous flow (PVF) parameters can be used to estimate left ventricular end-diastolic pressure (LVEDP) on transthoracic echocardiography. Despite that, 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) algorithm gave a secondary role to PVF to assess left ventricular filling pressure. We aimed to test correlations between several PVF parameters, including novel measurements, with LVEDP and to analyze whether PVF parameters have an incremental usefulness over ASE/EACVI algorithm to estimate LVEDP. Seventy-two patients that underwent left and right cardiac catheterization for assessment of heart failure or pulmonary hypertension were enrolled. All patients had a detailed echocardiographic study immediately before catheterization. Patients were categorized into those with an LVEDP < 15 mmHg vs. LVEDP ≥ 15 mmHg to analyze data. Patients with an elevated LVEDP had significantly lower peak S/D velocity ratio, S wave deceleration time, D wave acceleration time and D wave deceleration time (DWDT), as well as higher D wave acceleration rate (DWAR), but only peak S/D velocity ratio (ß = - 0.28, p = 0.01), DWDT (ß = - 0.33, p = 0.001) and DWAR (ß = 0.23, p = 0.03) were independent predictors for an elevated LVEDP. ASE/EACVI algorithm had a sensitivity of 71% and specificity of 74% to predict an elevated LVEDP. When PVF parameters were adjusted for ASE/EACVI algorithm; DWDT and DWAR remained as independent predictors. Sensitivity and specificity of ASE/EACVI algorithm increased to 79% and 96%, respectively, if either DWDT or DWAR was also suggestive of an elevated LVEDP. DWDT and DWAR have incremental usefulness over existing algorithm to determine LVEDP.


Assuntos
Ecocardiografia Doppler de Pulso , Insuficiência Cardíaca/diagnóstico por imagem , Hipertensão Pulmonar/diagnóstico por imagem , Circulação Pulmonar , Veias Pulmonares/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Pressão Ventricular , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Cateterismo Cardíaco , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Veias Pulmonares/fisiopatologia , Reprodutibilidade dos Testes , Disfunção Ventricular Esquerda/fisiopatologia
14.
BMC Infect Dis ; 20(1): 370, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448130

RESUMO

BACKGROUND: Brain abscesses, a severe infectious disease of the CNS, are usually caused by a variety of different pathogens, which include Streptococcus intermedius (S. intermedius). Pulmonary arteriovenous fistulas (PAVFs), characterized by abnormal direct communication between pulmonary artery and vein, are a rare underlying cause of brain abscesses. CASE PRESENTATION: The patient was a previous healthy 55-year-old man who presented with 5 days of headache and fever. Cerebral magnetic resonance imaging (MRI) suggested a brain abscess. Thoracic CT scan and angiography demonstrated PAVFs. Aiding by metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid (CSF) sample which identified S. intermedius as the causative pathogen, the patient was switched to the single therapy of large dose of penicillin G and was cured precisely and economically. CONCLUSIONS: It is an alternative way to perform mNGS to identify causative pathogens in patients with brain abscesses especially when the results of traditional bacterial culture were negative. Further thoracic CT or pulmonary angiography should also be undertaken to rule out PAVFs as the potential cause of brain abscess if the patient without any known premorbid history.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Penicilina G/uso terapêutico , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus intermedius/genética , Fístula Arteriovenosa/complicações , Abscesso Encefálico/líquido cefalorraquidiano , Abscesso Encefálico/microbiologia , Angiografia por Tomografia Computadorizada , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Infecções Estreptocócicas/líquido cefalorraquidiano , Infecções Estreptocócicas/microbiologia , Streptococcus intermedius/isolamento & purificação , Resultado do Tratamento
15.
Transl Res ; 223: 25-39, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32438072

RESUMO

Chronic obstructive pulmonary disease (COPD) increases the risk of atrial fibrillation (AF), however, its arrhythmogenic mechanisms are unclear. This study investigated the effects of COPD on AF triggers (pulmonary veins, PVs) and substrates (atria), and their potential underlying mechanisms. Electrocardiographic, echocardiographic, and biochemical studies were conducted in control rabbits and rabbits with human leukocyte elastase (0.3 unit/kg)-induced COPD. Conventional microelectrode, Western blotting, and histological examinations were performed on PV, left atrium (LA), right atrium, and sinoatrial node (SAN) preparations from control rabbits and those with COPD. The rabbits with COPD had a higher incidence of atrial premature complexes, PV burst firing and delayed afterdepolarizations, higher sympathetic activity, larger LA, and faster PV spontaneous activity than did the control rabbits; but they exhibited a slower SAN beating rate. The LA of the rabbits with COPD had a shorter action potential duration and longer tachyarrhythmia induced by tachypacing (20 Hz) and isoproterenol (1 µM). Additionally, the rabbits with COPD had higher fibrosis in the PVs, LA, and SAN. H89 (10 µM), KN93 (1 µM), and KB-R7943 (10 µM) significantly suppressed burst firing and delayed afterdepolarizations in the PVs of the rabbits with COPD. Moreover, compared with the control rabbits, those with COPD had lower expression levels of the ß1 adrenergic receptor, Cav 1.2, and Na+/Ca2+ exchanger in the PVs; Cav 1.2 in the LA; and hyperpolarization-activated cyclic nucleotide-gated K+ channel 4 in the SAN. COPD increases atrial arrhythmogenesis by modulating the distinctive electrophysiological characteristics of the PVs, LA, and SAN.


Assuntos
Arritmias Cardíacas/complicações , Átrios do Coração/patologia , Doença Pulmonar Obstrutiva Crônica/complicações , Animais , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/fisiopatologia , Modelos Animais de Doenças , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Frequência Cardíaca , Pulmão/fisiopatologia , Masculino , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Coelhos , Nó Sinoatrial/diagnóstico por imagem , Nó Sinoatrial/fisiopatologia
16.
Radiología (Madr., Ed. impr.) ; 62(2): 148-159, mar.-abr. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194212

RESUMO

OBJETIVOS: Conocer la anatomía de las venas pulmonares (VVPP) mediante tomografía computarizada multidetector (TCMD) en pacientes con fibrilación auricular (FA) antes de la ablación. MATERIAL Y MÉTODOS: Realizamos TCMD a 89 pacientes con FA analizando número, variantes y venas accesorias pulmonares, diámetro y forma ostia, distancia a la primera bifurcación y trombo en la orejuela izquierda. RESULTADOS: El patrón venoso pulmonar más frecuente fue 4 VVPP (dos derechas y dos izquierdas) en 49 pacientes (55,1%). Las VVPP superiores presentaron mayor diámetro ostial que las inferiores [vena pulmonar superior derecha (VPSD)> vena pulmonar inferior derecha (VPID); p = 0,001 y vena pulmonar superior izquierda (VPSI)> vena pulmonar inferior izquierda (VPII); p <0,001]. El diámetro ostial de las VVPP derechas era mayor que el de las izquierdas (VPSD> VPSI; p <0,001 y VPID> VPII; p <0,001). El ostium más circular lo presentó la VPID (ratio: 0,885) respecto a la VPII (p <0,001) y a la VPSI (p <0,001). La distancia a la primera bifurcación ha sido mayor en las venas superiores (VPSD> VPID; p = 0,008 y VPSI> VPII; p = 0,038). La distancia a la primera bifurcación fue mayor en las VVPP izquierdas (VPSI> VPSD; p <0,001 y VPII> VPID; p <0,001). Otros hallazgos fueron: divertículos (30), apéndices auriculares accesorios (5), aneurismas septales (8), bolsas septales (6) y 1 trombo en la orejuela izquierda. CONCLUSIÓN: La TCMD antes de la ablación demuestra la anatomía de la aurícula izquierda (AI) y de las VVPP con diferencias significativas entre los diámetros y morfología de los ostia venosos


OBJECTIVE: To know the anatomy of the pulmonary veins (PVs) by multidetector computed tomography (MDCT) in patients with atrial fibrillation (AF) prior to ablation. MATERIALS AND METHODS: MDCT was performed in 89 patients with AF, analyzing the number of PVs, accessory variants and veins, diameter and ostial shape, distance to the first bifurcation and thrombus in the left atrial appendage. RESULTS: The most frequent venous pattern was 4 PVs (two right and two left) in 49 patients (55.1%). The superior veins had a statistically significant greater mean ostial diameter than the inferior veins (Right Superior Pulmonary Vein (RSPV)> Right Inferior Pulmonary Vein (RIPV); p = 0.001 and Left Superior Pulmonary Vein (LSPV)> Left Inferior Pulmonary Vein (LIPV); p < 0.001). The right pulmonary veins ostial diameters were significantly larger than the left pulmonary veins ostial diameters (RSPV> LSPV; p < 0.001 and RIPV> LIPV; p < 0.001). The most circular ostium was presented by the VPID (ratio: 0.885) compared to the LIPV (p<00.1) and LSPV (p < 0.001). The superior veins had a statistically significant greater mean distance to first bifurcation than the inferior veins (RSPV> RIPV; p = 0.008 and LSPV> LIPV; p = 0.038). Mean distance to first bifurcation has been greater in left PVs respect to the right PVs (LSPV> RSPV; p < 0.001and LIPV> RIPV; p < 0.001). Other findings found in AI: diverticula (30), accessory auricular appendages (5), septal aneurysms (8), septal bags (6) and 1 thrombus in the left atrial appendage. CONCLUSION: MDCT prior to ablation demonstrates the anatomy of the left atrium (LA) and pulmonary veins with significant differences between the diameters and morphology of the venous ostia


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Tomografia Computadorizada Multidetectores/métodos , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Veias Pulmonares/diagnóstico por imagem , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Apêndice Atrial/diagnóstico por imagem
18.
J Card Surg ; 35(5): 1104-1105, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32267014

RESUMO

We present a case of rare double drainage of total anomalous pulmonary venous connection, which was diagnosed on a dual-source CT scanner. This case also highlights the critical role of volume-rendered images for preoperative planning.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Síndrome de Cimitarra/diagnóstico por imagem , Síndrome de Cimitarra/cirurgia , Pré-Escolar , Humanos , Planejamento de Assistência ao Paciente , Doenças Raras
19.
Medicine (Baltimore) ; 99(16): e19815, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312001

RESUMO

RATIONALE: Meandering pulmonary vein is a rare congenital pulmonary vascular anomaly. It presents unilateral single pulmonary vein that takes a circuitous route in the lung and drains normally into the left atrium. Most cases of meandering pulmonary vein have been reported to be right-sided. A few of them coincided with features of scimitar syndrome. PATIENT CONCERNS: A 71-year-old woman and a 20-year-old man presented with incidentally found abnormal findings on chest radiographs. DIAGNOSIS: Through multi-detector chest computed tomography, the 71-year-old woman was diagnosed as left-sided meandering pulmonary vein without any other anomalies while the 20-year-old man was diagnosed as having right-sided meandering pulmonary vein with features of scimitar syndrome. INTERVENTIONS: Specific intervention was not performed for either patient. OUTCOMES: These patients were reassured and discharged. They are doing well without any respiratory symptoms. LESSONS: Meandering pulmonary veins can occur on the left side and coincide with features of scimitar syndrome. Multi-detector computed tomography with 3D reconstruction allows clear depiction of vascular connections and associated anomalies, obviating the need for invasive procedures.


Assuntos
Pulmão/irrigação sanguínea , Veias Pulmonares/anormalidades , Síndrome de Cimitarra/diagnóstico por imagem , Idoso , Feminino , Humanos , Achados Incidentais , Pulmão/patologia , Masculino , Tomografia Computadorizada Multidetectores/métodos , Alta do Paciente/normas , Veias Pulmonares/diagnóstico por imagem , Radiografia Torácica/métodos , Adulto Jovem
20.
Surg Today ; 50(9): 1081-1090, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32200429

RESUMO

PURPOSE: To identify and clarify the comprehensive anatomic patterns in the left lower lobe (LLL). METHODS: Using computed tomography (CT) imaging data, including that obtained using three-dimensional CT, we reviewed the anatomic patterns of the pulmonary vessels and bronchi in the left lungs of 539 patients, focusing on the LLL. RESULTS: The two-stem type in A6 was observed in 131 (24.7%) patients and the three-stem type in A6 was observed in 11 (2.1%) patients. The independent two-stem type in B6 was observed in four (0.75%) patients. The B7 with independent branching from the basal bronchi was observed in 42 (7.9%) patients. B* was observed in 129 (24.0%) patients and B* was accompanied by A* in all patients. An extrapericardial common trunk of the left pulmonary veins was identified in five patients (0.93%). CONCLUSION: We identified various bronchovascular patterns in the LLL of a large number of patients. Our results provide useful information for anatomic pulmonary resection, especially segmentectomy.


Assuntos
Variação Anatômica , Brônquios/anatomia & histologia , Pulmão/anatomia & histologia , Pulmão/irrigação sanguínea , Artéria Pulmonar/anatomia & histologia , Veias Pulmonares/anatomia & histologia , Idoso , Brônquios/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional , Pulmão/diagnóstico por imagem , Masculino , Pneumonectomia , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA