DOI: 10.1148/rg.256055516
Pulmonary Artery Interventions: An Overview1
Jean-Pierre Pelage, MD, PhD,
Mostafa El Hajjam, MD,
Christine Lagrange, MD,
Thierry Chinet, MD,
Antoine Vieillard-Baron, MD,
Sophie Chagnon, MD and
Pascal Lacombe, MD
1 From the Departments of Radiology (J.P.P., M.E.H., C.L., S.C., P.L.), Pulmonology (T.C.), and Critical Care (A.V.B.), Hôpital Ambroise Paré, 9 ave Charles-de-Gaulle, 92104 Boulogne Cedex, France. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received March 28, 2005; revision requested April 25 and received July 26; accepted August 1. All authors have no financial relationships to disclose.
View larger version (131K):
[in a new window]
|
Figure 1a. Massive pulmonary embolism in a 65-year-old man. (a) Angiogram obtained with selective left pulmonary artery injection depicts multiple filling defects (arrows). (b) Angiogram obtained after catheter-based thrombolysis performed by using streptokinase shows reestablished perfusion via the left descending pulmonary artery (arrows).
|
|
View larger version (134K):
[in a new window]
|
Figure 1b. Massive pulmonary embolism in a 65-year-old man. (a) Angiogram obtained with selective left pulmonary artery injection depicts multiple filling defects (arrows). (b) Angiogram obtained after catheter-based thrombolysis performed by using streptokinase shows reestablished perfusion via the left descending pulmonary artery (arrows).
|
|
View larger version (143K):
[in a new window]
|
Figure 2a. Massive hemoptysis in a 50-year-old woman with Takayasu arteritis and systemic hypervascularization of the upper lobe of the right lung depicted at aortography. (a) Anteroposterior projection obtained at angiography with selective injection in the right coronary artery (RCA) depicts an enlarged atrial artery branch (AB) supplying collateral flow to the right pulmonary artery (arrow). Embolization of the atrial artery was successfully performed with n-butyl-cyanoacrylate. (b) Angiogram obtained in the same session as a shows a stenosis (arrow) of the right pulmonary artery (A) that was subsequently treated with balloon angioplasty. (c, d) Angiograms obtained 13 years later, before mitral valve replacement, show no residual stenosis in the right pulmonary artery (c) and patency of the right coronary artery (arrowhead) with persistent occlusion of the atrial artery (arrow) (d).
|
|
View larger version (145K):
[in a new window]
|
Figure 2b. Massive hemoptysis in a 50-year-old woman with Takayasu arteritis and systemic hypervascularization of the upper lobe of the right lung depicted at aortography. (a) Anteroposterior projection obtained at angiography with selective injection in the right coronary artery (RCA) depicts an enlarged atrial artery branch (AB) supplying collateral flow to the right pulmonary artery (arrow). Embolization of the atrial artery was successfully performed with n-butyl-cyanoacrylate. (b) Angiogram obtained in the same session as a shows a stenosis (arrow) of the right pulmonary artery (A) that was subsequently treated with balloon angioplasty. (c, d) Angiograms obtained 13 years later, before mitral valve replacement, show no residual stenosis in the right pulmonary artery (c) and patency of the right coronary artery (arrowhead) with persistent occlusion of the atrial artery (arrow) (d).
|
|
View larger version (165K):
[in a new window]
|
Figure 2c. Massive hemoptysis in a 50-year-old woman with Takayasu arteritis and systemic hypervascularization of the upper lobe of the right lung depicted at aortography. (a) Anteroposterior projection obtained at angiography with selective injection in the right coronary artery (RCA) depicts an enlarged atrial artery branch (AB) supplying collateral flow to the right pulmonary artery (arrow). Embolization of the atrial artery was successfully performed with n-butyl-cyanoacrylate. (b) Angiogram obtained in the same session as a shows a stenosis (arrow) of the right pulmonary artery (A) that was subsequently treated with balloon angioplasty. (c, d) Angiograms obtained 13 years later, before mitral valve replacement, show no residual stenosis in the right pulmonary artery (c) and patency of the right coronary artery (arrowhead) with persistent occlusion of the atrial artery (arrow) (d).
|
|
View larger version (161K):
[in a new window]
|
Figure 2d. Massive hemoptysis in a 50-year-old woman with Takayasu arteritis and systemic hypervascularization of the upper lobe of the right lung depicted at aortography. (a) Anteroposterior projection obtained at angiography with selective injection in the right coronary artery (RCA) depicts an enlarged atrial artery branch (AB) supplying collateral flow to the right pulmonary artery (arrow). Embolization of the atrial artery was successfully performed with n-butyl-cyanoacrylate. (b) Angiogram obtained in the same session as a shows a stenosis (arrow) of the right pulmonary artery (A) that was subsequently treated with balloon angioplasty. (c, d) Angiograms obtained 13 years later, before mitral valve replacement, show no residual stenosis in the right pulmonary artery (c) and patency of the right coronary artery (arrowhead) with persistent occlusion of the atrial artery (arrow) (d).
|
|
View larger version (113K):
[in a new window]
|
Figure 3a. Chronic thromboembolic disease in a 70-year-old woman with equal high pulmonary artery and arterial pressures. (a) Angiogram shows marked stenosis (arrow) of the pulmonary artery in the middle lobe of the right lung and a poststenotic aneurysm (A). Because surgery was considered too risky, balloon angioplasty was performed. (b) Angiogram shows inflation of the balloon during angioplasty. (c) Angiogram obtained after angioplasty shows improved enhancement (arrows) that corresponds to a marked redistribution of blood flow throughout the middle lobe of the lung. The patient died of severe reperfusion edema 7 days after angioplasty.
|
|
View larger version (123K):
[in a new window]
|
Figure 3b. Chronic thromboembolic disease in a 70-year-old woman with equal high pulmonary artery and arterial pressures. (a) Angiogram shows marked stenosis (arrow) of the pulmonary artery in the middle lobe of the right lung and a poststenotic aneurysm (A). Because surgery was considered too risky, balloon angioplasty was performed. (b) Angiogram shows inflation of the balloon during angioplasty. (c) Angiogram obtained after angioplasty shows improved enhancement (arrows) that corresponds to a marked redistribution of blood flow throughout the middle lobe of the lung. The patient died of severe reperfusion edema 7 days after angioplasty.
|
|
View larger version (169K):
[in a new window]
|
Figure 3c. Chronic thromboembolic disease in a 70-year-old woman with equal high pulmonary artery and arterial pressures. (a) Angiogram shows marked stenosis (arrow) of the pulmonary artery in the middle lobe of the right lung and a poststenotic aneurysm (A). Because surgery was considered too risky, balloon angioplasty was performed. (b) Angiogram shows inflation of the balloon during angioplasty. (c) Angiogram obtained after angioplasty shows improved enhancement (arrows) that corresponds to a marked redistribution of blood flow throughout the middle lobe of the lung. The patient died of severe reperfusion edema 7 days after angioplasty.
|
|
View larger version (160K):
[in a new window]
|
Figure 4a. Carcinoma of the lung in a 50-year-old man. (a) Chest radiograph depicts upper-lobe consolidation and central excavation in the right lung. (b, c) Contrast-enhanced axial (b) and coronal (c) CT scans of the chest show a cavitated perihilar mass (* in b) with nodular enhancement inside the cavity (arrow), findings that are consistent with a pseudoaneurysm. (d) Angiogram of the right pulmonary artery helps confirm the presence of a pseudoaneurysm (arrow). (e) Digital subtraction angiogram shows reduction of blood flow in the arterial branches to the lower and middle lobes with coil embolization, and packing of the pseudoaneurysm (arrow) with n-butyl-cyanoacrylate and coils. (f) Unenhanced chest CT scan (mediastinal window settings), obtained after embolization, depicts complete occlusion of the pseudoaneurysm.
|
|
View larger version (123K):
[in a new window]
|
Figure 4b. Carcinoma of the lung in a 50-year-old man. (a) Chest radiograph depicts upper-lobe consolidation and central excavation in the right lung. (b, c) Contrast-enhanced axial (b) and coronal (c) CT scans of the chest show a cavitated perihilar mass (* in b) with nodular enhancement inside the cavity (arrow), findings that are consistent with a pseudoaneurysm. (d) Angiogram of the right pulmonary artery helps confirm the presence of a pseudoaneurysm (arrow). (e) Digital subtraction angiogram shows reduction of blood flow in the arterial branches to the lower and middle lobes with coil embolization, and packing of the pseudoaneurysm (arrow) with n-butyl-cyanoacrylate and coils. (f) Unenhanced chest CT scan (mediastinal window settings), obtained after embolization, depicts complete occlusion of the pseudoaneurysm.
|
|
View larger version (99K):
[in a new window]
|
Figure 4c. Carcinoma of the lung in a 50-year-old man. (a) Chest radiograph depicts upper-lobe consolidation and central excavation in the right lung. (b, c) Contrast-enhanced axial (b) and coronal (c) CT scans of the chest show a cavitated perihilar mass (* in b) with nodular enhancement inside the cavity (arrow), findings that are consistent with a pseudoaneurysm. (d) Angiogram of the right pulmonary artery helps confirm the presence of a pseudoaneurysm (arrow). (e) Digital subtraction angiogram shows reduction of blood flow in the arterial branches to the lower and middle lobes with coil embolization, and packing of the pseudoaneurysm (arrow) with n-butyl-cyanoacrylate and coils. (f) Unenhanced chest CT scan (mediastinal window settings), obtained after embolization, depicts complete occlusion of the pseudoaneurysm.
|
|
View larger version (128K):
[in a new window]
|
Figure 4d. Carcinoma of the lung in a 50-year-old man. (a) Chest radiograph depicts upper-lobe consolidation and central excavation in the right lung. (b, c) Contrast-enhanced axial (b) and coronal (c) CT scans of the chest show a cavitated perihilar mass (* in b) with nodular enhancement inside the cavity (arrow), findings that are consistent with a pseudoaneurysm. (d) Angiogram of the right pulmonary artery helps confirm the presence of a pseudoaneurysm (arrow). (e) Digital subtraction angiogram shows reduction of blood flow in the arterial branches to the lower and middle lobes with coil embolization, and packing of the pseudoaneurysm (arrow) with n-butyl-cyanoacrylate and coils. (f) Unenhanced chest CT scan (mediastinal window settings), obtained after embolization, depicts complete occlusion of the pseudoaneurysm.
|
|
View larger version (156K):
[in a new window]
|
Figure 4e. Carcinoma of the lung in a 50-year-old man. (a) Chest radiograph depicts upper-lobe consolidation and central excavation in the right lung. (b, c) Contrast-enhanced axial (b) and coronal (c) CT scans of the chest show a cavitated perihilar mass (* in b) with nodular enhancement inside the cavity (arrow), findings that are consistent with a pseudoaneurysm. (d) Angiogram of the right pulmonary artery helps confirm the presence of a pseudoaneurysm (arrow). (e) Digital subtraction angiogram shows reduction of blood flow in the arterial branches to the lower and middle lobes with coil embolization, and packing of the pseudoaneurysm (arrow) with n-butyl-cyanoacrylate and coils. (f) Unenhanced chest CT scan (mediastinal window settings), obtained after embolization, depicts complete occlusion of the pseudoaneurysm.
|
|
View larger version (122K):
[in a new window]
|
Figure 4f. Carcinoma of the lung in a 50-year-old man. (a) Chest radiograph depicts upper-lobe consolidation and central excavation in the right lung. (b, c) Contrast-enhanced axial (b) and coronal (c) CT scans of the chest show a cavitated perihilar mass (* in b) with nodular enhancement inside the cavity (arrow), findings that are consistent with a pseudoaneurysm. (d) Angiogram of the right pulmonary artery helps confirm the presence of a pseudoaneurysm (arrow). (e) Digital subtraction angiogram shows reduction of blood flow in the arterial branches to the lower and middle lobes with coil embolization, and packing of the pseudoaneurysm (arrow) with n-butyl-cyanoacrylate and coils. (f) Unenhanced chest CT scan (mediastinal window settings), obtained after embolization, depicts complete occlusion of the pseudoaneurysm.
|
|
View larger version (156K):
[in a new window]
|
Figure 5a. Cardiac failure due to pulmonary artery rupture in an 89-year-old man after Swan-Ganz catheterization. (a) Chest radiograph shows an apparent nodule (arrow) in the middle lobe, a finding that is consistent with a pseudoaneurysm. (b) Contrast-enhanced CT scan of the chest (mediastinal window settings) helps confirm the presence and location of the pseudoaneurysm (arrow). (c) Pulmonary angiogram obtained after selective injection in the feeding artery clearly shows the extent of the pseudoaneurysm (arrow). (d) Postembolization digital subtraction angiogram depicts complete occlusion of the pseudoaneurysm (arrow) with coils.
|
|
View larger version (147K):
[in a new window]
|
Figure 5b. Cardiac failure due to pulmonary artery rupture in an 89-year-old man after Swan-Ganz catheterization. (a) Chest radiograph shows an apparent nodule (arrow) in the middle lobe, a finding that is consistent with a pseudoaneurysm. (b) Contrast-enhanced CT scan of the chest (mediastinal window settings) helps confirm the presence and location of the pseudoaneurysm (arrow). (c) Pulmonary angiogram obtained after selective injection in the feeding artery clearly shows the extent of the pseudoaneurysm (arrow). (d) Postembolization digital subtraction angiogram depicts complete occlusion of the pseudoaneurysm (arrow) with coils.
|
|
View larger version (140K):
[in a new window]
|
Figure 5c. Cardiac failure due to pulmonary artery rupture in an 89-year-old man after Swan-Ganz catheterization. (a) Chest radiograph shows an apparent nodule (arrow) in the middle lobe, a finding that is consistent with a pseudoaneurysm. (b) Contrast-enhanced CT scan of the chest (mediastinal window settings) helps confirm the presence and location of the pseudoaneurysm (arrow). (c) Pulmonary angiogram obtained after selective injection in the feeding artery clearly shows the extent of the pseudoaneurysm (arrow). (d) Postembolization digital subtraction angiogram depicts complete occlusion of the pseudoaneurysm (arrow) with coils.
|
|
View larger version (181K):
[in a new window]
|
Figure 5d. Cardiac failure due to pulmonary artery rupture in an 89-year-old man after Swan-Ganz catheterization. (a) Chest radiograph shows an apparent nodule (arrow) in the middle lobe, a finding that is consistent with a pseudoaneurysm. (b) Contrast-enhanced CT scan of the chest (mediastinal window settings) helps confirm the presence and location of the pseudoaneurysm (arrow). (c) Pulmonary angiogram obtained after selective injection in the feeding artery clearly shows the extent of the pseudoaneurysm (arrow). (d) Postembolization digital subtraction angiogram depicts complete occlusion of the pseudoaneurysm (arrow) with coils.
|
|
View larger version (109K):
[in a new window]
|
Figure 6a. Large pulmonary artery pseudoaneurysm in a 28-year-old man with Behçet disease. (a) Contrast-enhanced CT scan depicts a large left pulmonary artery pseudoaneurysm (arrow). (b) Angiogram shows successful selective embolization of the pseudoaneurysm with multiple coils.
|
|
View larger version (167K):
[in a new window]
|
Figure 6b. Large pulmonary artery pseudoaneurysm in a 28-year-old man with Behçet disease. (a) Contrast-enhanced CT scan depicts a large left pulmonary artery pseudoaneurysm (arrow). (b) Angiogram shows successful selective embolization of the pseudoaneurysm with multiple coils.
|
|
View larger version (127K):
[in a new window]
|
Figure 7a. Bilateral pulmonary artery pseudoaneurysms in a 34-year-old man with Behçet disease. (a, b) Angiograms obtained with selective injection in the right (a) and left (b) pulmonary arteries depict bilateral pseudoaneurysms (arrow) and the occlusion of distal pulmonary artery branches (*). Selective embolization of the two right pulmonary artery pseudoaneurysms in a was successfully performed by using coils. (c) The balloon-assisted technique (arrow) was used for embolization in the left pulmonary artery. (d) Follow-up CT scan demonstrates the complete occlusion of the pseudoaneurysms.
|
|
View larger version (119K):
[in a new window]
|
Figure 7b. Bilateral pulmonary artery pseudoaneurysms in a 34-year-old man with Behçet disease. (a, b) Angiograms obtained with selective injection in the right (a) and left (b) pulmonary arteries depict bilateral pseudoaneurysms (arrow) and the occlusion of distal pulmonary artery branches (*). Selective embolization of the two right pulmonary artery pseudoaneurysms in a was successfully performed by using coils. (c) The balloon-assisted technique (arrow) was used for embolization in the left pulmonary artery. (d) Follow-up CT scan demonstrates the complete occlusion of the pseudoaneurysms.
|
|
View larger version (150K):
[in a new window]
|
Figure 7c. Bilateral pulmonary artery pseudoaneurysms in a 34-year-old man with Behçet disease. (a, b) Angiograms obtained with selective injection in the right (a) and left (b) pulmonary arteries depict bilateral pseudoaneurysms (arrow) and the occlusion of distal pulmonary artery branches (*). Selective embolization of the two right pulmonary artery pseudoaneurysms in a was successfully performed by using coils. (c) The balloon-assisted technique (arrow) was used for embolization in the left pulmonary artery. (d) Follow-up CT scan demonstrates the complete occlusion of the pseudoaneurysms.
|
|
View larger version (112K):
[in a new window]
|
Figure 7d. Bilateral pulmonary artery pseudoaneurysms in a 34-year-old man with Behçet disease. (a, b) Angiograms obtained with selective injection in the right (a) and left (b) pulmonary arteries depict bilateral pseudoaneurysms (arrow) and the occlusion of distal pulmonary artery branches (*). Selective embolization of the two right pulmonary artery pseudoaneurysms in a was successfully performed by using coils. (c) The balloon-assisted technique (arrow) was used for embolization in the left pulmonary artery. (d) Follow-up CT scan demonstrates the complete occlusion of the pseudoaneurysms.
|
|
View larger version (127K):
[in a new window]
|
Figure 8. Recurrent hemoptysis 1 week after embolization of two pulmonary artery pseudoaneurysms in a 43-year-old man with Behçet disease. Angiogram obtained with selective injection in a common right-left bronchial artery (BA) depicts diffuse pulmonary hypervascularization, with opacification of pulmonary artery branches (arrowheads) distal to the embolized pseudoaneurysms (arrows). Bleeding ceased completely after bronchial artery embolization.
|
|
View larger version (122K):
[in a new window]
|
Figure 9a. Pulmonary artery aneurysm in a 78-year-old woman with a chronic cough. (a) Chest radiograph, obtained 6 years after an initial radiographic finding of a pulmonary nodule in the left lung, shows an increase in the size of the nodule (arrow). (b) Maximum intensity projection obtained at contrast-enhanced multisection CT depicts a 3-cm-diameter aneurysm in the apical pulmonary artery of the culmen. (c) Pulmonary angiogram demonstrates the presence and location of the aneurysm (arrow). (d) Angiogram shows selective embolization of the arterial supply to the aneurysm with the use of detachable microcoils (arrow). (e) Postembolization CT scan shows complete exclusion of the aneurysm, with patency maintained in the distal pulmonary artery branches (arrow). (f) Chest radiograph shows the occluded aneurysm.
|
|
View larger version (150K):
[in a new window]
|
Figure 9b. Pulmonary artery aneurysm in a 78-year-old woman with a chronic cough. (a) Chest radiograph, obtained 6 years after an initial radiographic finding of a pulmonary nodule in the left lung, shows an increase in the size of the nodule (arrow). (b) Maximum intensity projection obtained at contrast-enhanced multisection CT depicts a 3-cm-diameter aneurysm in the apical pulmonary artery of the culmen. (c) Pulmonary angiogram demonstrates the presence and location of the aneurysm (arrow). (d) Angiogram shows selective embolization of the arterial supply to the aneurysm with the use of detachable microcoils (arrow). (e) Postembolization CT scan shows complete exclusion of the aneurysm, with patency maintained in the distal pulmonary artery branches (arrow). (f) Chest radiograph shows the occluded aneurysm.
|
|
View larger version (137K):
[in a new window]
|
Figure 9c. Pulmonary artery aneurysm in a 78-year-old woman with a chronic cough. (a) Chest radiograph, obtained 6 years after an initial radiographic finding of a pulmonary nodule in the left lung, shows an increase in the size of the nodule (arrow). (b) Maximum intensity projection obtained at contrast-enhanced multisection CT depicts a 3-cm-diameter aneurysm in the apical pulmonary artery of the culmen. (c) Pulmonary angiogram demonstrates the presence and location of the aneurysm (arrow). (d) Angiogram shows selective embolization of the arterial supply to the aneurysm with the use of detachable microcoils (arrow). (e) Postembolization CT scan shows complete exclusion of the aneurysm, with patency maintained in the distal pulmonary artery branches (arrow). (f) Chest radiograph shows the occluded aneurysm.
|
|
View larger version (139K):
[in a new window]
|
Figure 9d. Pulmonary artery aneurysm in a 78-year-old woman with a chronic cough. (a) Chest radiograph, obtained 6 years after an initial radiographic finding of a pulmonary nodule in the left lung, shows an increase in the size of the nodule (arrow). (b) Maximum intensity projection obtained at contrast-enhanced multisection CT depicts a 3-cm-diameter aneurysm in the apical pulmonary artery of the culmen. (c) Pulmonary angiogram demonstrates the presence and location of the aneurysm (arrow). (d) Angiogram shows selective embolization of the arterial supply to the aneurysm with the use of detachable microcoils (arrow). (e) Postembolization CT scan shows complete exclusion of the aneurysm, with patency maintained in the distal pulmonary artery branches (arrow). (f) Chest radiograph shows the occluded aneurysm.
|
|
View larger version (164K):
[in a new window]
|
Figure 9e. Pulmonary artery aneurysm in a 78-year-old woman with a chronic cough. (a) Chest radiograph, obtained 6 years after an initial radiographic finding of a pulmonary nodule in the left lung, shows an increase in the size of the nodule (arrow). (b) Maximum intensity projection obtained at contrast-enhanced multisection CT depicts a 3-cm-diameter aneurysm in the apical pulmonary artery of the culmen. (c) Pulmonary angiogram demonstrates the presence and location of the aneurysm (arrow). (d) Angiogram shows selective embolization of the arterial supply to the aneurysm with the use of detachable microcoils (arrow). (e) Postembolization CT scan shows complete exclusion of the aneurysm, with patency maintained in the distal pulmonary artery branches (arrow). (f) Chest radiograph shows the occluded aneurysm.
|
|
View larger version (137K):
[in a new window]
|
Figure 9f. Pulmonary artery aneurysm in a 78-year-old woman with a chronic cough. (a) Chest radiograph, obtained 6 years after an initial radiographic finding of a pulmonary nodule in the left lung, shows an increase in the size of the nodule (arrow). (b) Maximum intensity projection obtained at contrast-enhanced multisection CT depicts a 3-cm-diameter aneurysm in the apical pulmonary artery of the culmen. (c) Pulmonary angiogram demonstrates the presence and location of the aneurysm (arrow). (d) Angiogram shows selective embolization of the arterial supply to the aneurysm with the use of detachable microcoils (arrow). (e) Postembolization CT scan shows complete exclusion of the aneurysm, with patency maintained in the distal pulmonary artery branches (arrow). (f) Chest radiograph shows the occluded aneurysm.
|
|
View larger version (133K):
[in a new window]
|
Figure 10a. Simple arteriovenous malformation in a 43-year-old man with hereditary hemorrhagic telangiectasia. (a) Coronal maximum intensity projection obtained at multisection CT depicts a simple arteriovenous malformation of the pulmonary lingula (arrow). (b) Selective pulmonary angiogram demonstrates the type of malformation. A feeding artery (A), sac (S), and draining vein (V) are well depicted. (c) Angiogram obtained during the same session as b shows complete occlusion of the malformation with coils (arrow).
|
|
View larger version (138K):
[in a new window]
|
Figure 10b. Simple arteriovenous malformation in a 43-year-old man with hereditary hemorrhagic telangiectasia. (a) Coronal maximum intensity projection obtained at multisection CT depicts a simple arteriovenous malformation of the pulmonary lingula (arrow). (b) Selective pulmonary angiogram demonstrates the type of malformation. A feeding artery (A), sac (S), and draining vein (V) are well depicted. (c) Angiogram obtained during the same session as b shows complete occlusion of the malformation with coils (arrow).
|
|
View larger version (148K):
[in a new window]
|
Figure 10c. Simple arteriovenous malformation in a 43-year-old man with hereditary hemorrhagic telangiectasia. (a) Coronal maximum intensity projection obtained at multisection CT depicts a simple arteriovenous malformation of the pulmonary lingula (arrow). (b) Selective pulmonary angiogram demonstrates the type of malformation. A feeding artery (A), sac (S), and draining vein (V) are well depicted. (c) Angiogram obtained during the same session as b shows complete occlusion of the malformation with coils (arrow).
|
|
View larger version (141K):
[in a new window]
|
Figure 11a. Diffuse arteriovenous malformations in a 28-year-old woman with hereditary hemorrhagic telangiectasia and severe hypoxemia. (a) CT scan shows small malformations in subsegmental branches (arrows) of all the segmental pulmonary arteries. (b) Angiogram obtained with selective injection in the right pulmonary artery after four embolization sessions shows occlusion of the feeding vessels of the multiple malformations.
|
|
View larger version (133K):
[in a new window]
|
Figure 11b. Diffuse arteriovenous malformations in a 28-year-old woman with hereditary hemorrhagic telangiectasia and severe hypoxemia. (a) CT scan shows small malformations in subsegmental branches (arrows) of all the segmental pulmonary arteries. (b) Angiogram obtained with selective injection in the right pulmonary artery after four embolization sessions shows occlusion of the feeding vessels of the multiple malformations.
|
|
View larger version (158K):
[in a new window]
|
Figure 12a. Neurologic complication of hereditary hemorrhagic telangiectasia in a 47-year-old woman. (a) Brain MR image depicts an abscess (arrow). (b) CT scan shows a small pulmonary arteriovenous malformation in the right upper lobe (arrow). (c) Angiogram obtained with selective injection in a segmental branch of the apical right pulmonary artery depicts a simple malformation with a single 2.5-mm-diameter feeding artery (A) and draining vein (V). (d) Angiogram shows complete embolization of the malformation (arrow).
|
|
View larger version (93K):
[in a new window]
|
Figure 12b. Neurologic complication of hereditary hemorrhagic telangiectasia in a 47-year-old woman. (a) Brain MR image depicts an abscess (arrow). (b) CT scan shows a small pulmonary arteriovenous malformation in the right upper lobe (arrow). (c) Angiogram obtained with selective injection in a segmental branch of the apical right pulmonary artery depicts a simple malformation with a single 2.5-mm-diameter feeding artery (A) and draining vein (V). (d) Angiogram shows complete embolization of the malformation (arrow).
|
|
View larger version (165K):
[in a new window]
|
Figure 12c. Neurologic complication of hereditary hemorrhagic telangiectasia in a 47-year-old woman. (a) Brain MR image depicts an abscess (arrow). (b) CT scan shows a small pulmonary arteriovenous malformation in the right upper lobe (arrow). (c) Angiogram obtained with selective injection in a segmental branch of the apical right pulmonary artery depicts a simple malformation with a single 2.5-mm-diameter feeding artery (A) and draining vein (V). (d) Angiogram shows complete embolization of the malformation (arrow).
|
|
View larger version (157K):
[in a new window]
|
Figure 12d. Neurologic complication of hereditary hemorrhagic telangiectasia in a 47-year-old woman. (a) Brain MR image depicts an abscess (arrow). (b) CT scan shows a small pulmonary arteriovenous malformation in the right upper lobe (arrow). (c) Angiogram obtained with selective injection in a segmental branch of the apical right pulmonary artery depicts a simple malformation with a single 2.5-mm-diameter feeding artery (A) and draining vein (V). (d) Angiogram shows complete embolization of the malformation (arrow).
|
|
View larger version (110K):
[in a new window]
|
Figure 13a. Cardiac insufficiency in a 30-year-old woman with no history of pulmonary embolism or deep venous thrombosis and with normal pulmonary artery pressure at angiography and normal flow in lower-limb vessels at Doppler US. (a) Contrast-enhanced spiral CT scan depicts a filling defect in an artery (arrow) in the lower lobe of the left lung. Complete obstruction of the right pulmonary artery (not shown) also was found. (b) Selective pulmonary angiogram helps confirm the presence of the filling defect (arrow). (c) To exclude tumoral emboli, an endovascular biopsy was performed in the suspicious arterial segment (arrow). An organized thrombus was found at pathologic analysis, and the final diagnosis was thromboembolic disease.
|
|
View larger version (119K):
[in a new window]
|
Figure 13b. Cardiac insufficiency in a 30-year-old woman with no history of pulmonary embolism or deep venous thrombosis and with normal pulmonary artery pressure at angiography and normal flow in lower-limb vessels at Doppler US. (a) Contrast-enhanced spiral CT scan depicts a filling defect in an artery (arrow) in the lower lobe of the left lung. Complete obstruction of the right pulmonary artery (not shown) also was found. (b) Selective pulmonary angiogram helps confirm the presence of the filling defect (arrow). (c) To exclude tumoral emboli, an endovascular biopsy was performed in the suspicious arterial segment (arrow). An organized thrombus was found at pathologic analysis, and the final diagnosis was thromboembolic disease.
|
|
View larger version (100K):
[in a new window]
|
Figure 13c. Cardiac insufficiency in a 30-year-old woman with no history of pulmonary embolism or deep venous thrombosis and with normal pulmonary artery pressure at angiography and normal flow in lower-limb vessels at Doppler US. (a) Contrast-enhanced spiral CT scan depicts a filling defect in an artery (arrow) in the lower lobe of the left lung. Complete obstruction of the right pulmonary artery (not shown) also was found. (b) Selective pulmonary angiogram helps confirm the presence of the filling defect (arrow). (c) To exclude tumoral emboli, an endovascular biopsy was performed in the suspicious arterial segment (arrow). An organized thrombus was found at pathologic analysis, and the final diagnosis was thromboembolic disease.
|
|
View larger version (140K):
[in a new window]
|
Figure 14a. Retrieval of a catheter fragment in a 56-year-old man, 3 months after venous catheter implantation for chemotherapy of colorectal cancer. Angiograms show a long fragment of the venous catheter lodged in the main pulmonary artery (arrows in a), a pigtail catheter (arrow in b) used to dislodge the fragment, successful snaring (c) and extraction (d) of the fragment (arrow) from the pulmonary artery into the inferior vena cava (IVC), and, finally, emergence of the fragment at the femoral puncture site (e).
|
|
View larger version (134K):
[in a new window]
|
Figure 14b. Retrieval of a catheter fragment in a 56-year-old man, 3 months after venous catheter implantation for chemotherapy of colorectal cancer. Angiograms show a long fragment of the venous catheter lodged in the main pulmonary artery (arrows in a), a pigtail catheter (arrow in b) used to dislodge the fragment, successful snaring (c) and extraction (d) of the fragment (arrow) from the pulmonary artery into the inferior vena cava (IVC), and, finally, emergence of the fragment at the femoral puncture site (e).
|
|
View larger version (145K):
[in a new window]
|
Figure 14c. Retrieval of a catheter fragment in a 56-year-old man, 3 months after venous catheter implantation for chemotherapy of colorectal cancer. Angiograms show a long fragment of the venous catheter lodged in the main pulmonary artery (arrows in a), a pigtail catheter (arrow in b) used to dislodge the fragment, successful snaring (c) and extraction (d) of the fragment (arrow) from the pulmonary artery into the inferior vena cava (IVC), and, finally, emergence of the fragment at the femoral puncture site (e).
|
|
View larger version (144K):
[in a new window]
|
Figure 14d. Retrieval of a catheter fragment in a 56-year-old man, 3 months after venous catheter implantation for chemotherapy of colorectal cancer. Angiograms show a long fragment of the venous catheter lodged in the main pulmonary artery (arrows in a), a pigtail catheter (arrow in b) used to dislodge the fragment, successful snaring (c) and extraction (d) of the fragment (arrow) from the pulmonary artery into the inferior vena cava (IVC), and, finally, emergence of the fragment at the femoral puncture site (e).
|
|
View larger version (132K):
[in a new window]
|
Figure 14e. Retrieval of a catheter fragment in a 56-year-old man, 3 months after venous catheter implantation for chemotherapy of colorectal cancer. Angiograms show a long fragment of the venous catheter lodged in the main pulmonary artery (arrows in a), a pigtail catheter (arrow in b) used to dislodge the fragment, successful snaring (c) and extraction (d) of the fragment (arrow) from the pulmonary artery into the inferior vena cava (IVC), and, finally, emergence of the fragment at the femoral puncture site (e).
|
|
Copyright © 2005 by the Radiological Society of North America.
