Pulmonary vein (PV) stenosis is a complication of ablation therapy for arrhythmias. We report two cases with chronic lung parenchymal abnormalities showing no improvement and waxing and waning features, which were initially diagnosed as nonspecific pneumonias, and finally confirmed as PV stenosis. When a patient presents for nonspecific respiratory symptoms without evidence of infection after ablation therapy and image findings show chronic and repetitive parenchymal abnormalities confined in localized portion, the possibility of PV stenosis should be considered.
Atrial Fibrillation/surgery ; Catheter Ablation/*adverse effects/methods ; Constriction, Pathologic/diagnosis/*radiography ; *Diagnostic Errors ; Female ; Humans ; Lung/surgery ; Male ; Middle Aged ; Pneumonia/diagnosis ; Pulmonary Infarction/pathology/*radiography ; Pulmonary Veins/physiopathology/radiography ; Tomography, X-Ray Computed/adverse effects ; Vascular Diseases/physiopathology

PURPOSE: The association between pulmonary vein (PV) dilatation and stroke in non-valvular atrial fibrillation (AF) patients remains unknown. MATERIALS AND METHODS: We examined the left atrium (LA) and PV in control (n=138) and non-valvular AF patients without (AF group, n=138) and with non-hemorrhagic stroke (AF with stroke group, n=138) using computed tomography. RESULTS: The LA, LA appendage (LAA), and all PVs were larger in the AF than control patients. The orifice areas of the LAA (5.6+/-2.2 cm2 vs. 4.7+/-1.7 cm2, p<0.001), left superior PV (3.8+/-1.5 cm2 vs. 3.4+/-1.2 cm2, p=0.019), and inferior PV (2.3+/-1.0 cm2 vs. 1.8+/-0.7 cm2, p<0.001) were larger in the AF with stroke than in the AF only group. However, right PVs were not different between the two groups. In a multivariate analysis, the orifice areas of the left superior PV [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.03-1.51, p=0.02], left inferior PV (OR 1.97, 95% CI 1.41-2.75, p<0.001), and LAA (OR 1.30, 95% CI 1.13-1.50, p<0.001) were independent predictors of stroke. CONCLUSION: Compared to the right PVs, the left PVs and LAA exhibited more significant enlargement in patients with AF and stroke than in patients with AF only. This finding suggests that the remodeling of left-sided LA structures might be related to stroke.
Aged ; Atrial Appendage/physiopathology/*radiography ; Atrial Fibrillation/*complications/diagnosis/physiopathology ; Atrial Function, Right/*physiology ; Female ; Heart Atria ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography/*methods ; Multivariate Analysis ; Odds Ratio ; Predictive Value of Tests ; Prognosis ; Pulmonary Veins/physiopathology/*radiography ; Stroke/diagnosis/*etiology ; Tomography, X-Ray Computed/methods

Superior vena cava (SVC) obstruction is associated with the gradual development of venous collaterals. We present a rare form of systemic-to-pulmonary subpleural collateral pathway that developed in the bridging subpleural pulmonary veins in a 54-year-old woman with complete SVC obstruction. This uncommon collateral pathway represents a rare form of acquired right-to-left shunt due to previous pleural adhesions with an increased risk of stroke due to right-to-left venous shunting, which requires lifelong anticoagulation.
*Collateral Circulation/physiology ; Female ; Humans ; Middle Aged ; Multidetector Computed Tomography ; Phlebography/methods ; Pulmonary Veins/physiopathology/*radiography ; Stroke/complications ; Superior Vena Cava Syndrome/physiopathology/*radiography ; Veins/physiopathology

We present two cases of individual pulmonary vein atresia without vestige of an involved pulmonary vein. On CT, we noted the absence or interruption of normal pulmonary venous structures, and the presence of abnormal vascular structures that represented collaterals for the involved lung parenchyma. On angiography, the atretic pulmonary vein was found to drain into the other ipsilateral pulmonary veins through the collaterals.
Adult ; *Angiography ; Diagnosis, Differential ; Humans ; Male ; Pulmonary Atresia/*radiography ; Pulmonary Veins/*radiography ; *Tomography, X-Ray Computed

We report a case of central venous stenosis due to a structural deformity caused by a tuberculosis-destroyed lung in a 65-year-old woman. The patient presented with left facial edema. She had a history of pulmonary tuberculosis, and the chest X-ray revealed a collapsed left lung. Angiography showed leftward deviation of the innominate vein leading to kinking and stenosis of the internal jugular vein. Stent insertion improved her facial edema.
Aged ; Brachiocephalic Veins/*pathology/radiography ; *Central Venous Pressure ; Constriction, Pathologic/*etiology/pathology/therapy ; Edema/therapy ; Female ; Humans ; Jugular Veins/pathology/radiography ; Stents ; Tuberculosis, Pulmonary/*complications/pathology/radiography ; Vascular Diseases/*etiology/pathology/therapy

Protein C is an important physiological anticoagulant factor. Protein C deficiency has been linked to venous thrombosis at unusual sites, including the cerebral and mesenteric veins. Hereditary protein C deficiency is inherited primarily as an autosomal dominant trait with incomplete penetrance. Protein C and S deficiencies are known to increase the risk of venous thrombosis and pulmonary thromboembolism. Testing for protein C levels and function is necessary for the detection of both type I and type II protein C deficiency. In this article, we report a case of pulmonary embolism and mesentery ischemia due to type 1 protein C deficiency.
Colonoscopy ; Humans ; Ischemia/*diagnosis/etiology ; Magnetic Resonance Angiography ; Male ; Mesenteric Veins ; Middle Aged ; Protein C Deficiency/*complications/genetics ; Pulmonary Embolism/*diagnosis/etiology/radiography ; Tomography, X-Ray Computed

OBJECTIVE: To evaluate the clinical and radiological outcomes of transcatheter embolotherapy for treating sporadic pulmonary arteriovenous malformations (PAVMs) that were not associated with hereditary hemorrhagic telangiectasia. MATERIALS AND METHODS: Between January 2001 and June 2008, thirty-five sporadic PAVMs were detected in 23 patients. The clinical follow up consisted of assessing the changes of the signs and symptoms of the PAVMs, and radiological evaluation with chest radiographs or chest CT scans. RESULTS: The lower lung regions (63%) and peripheral locations (86%) were the common locations of the PAVMs. Thirty-four PAVMs (97%) had simple architecture (one arterial feeder within a single pulmonary segment). Technical success was achieved in 33 PAVMs (94%); two cases of technical failure were due to catheterization failure (n = 1) and too large a feeding artery (17 mm) that disabled embolotherapy (n = 1). Coils and Amplatz vascular plugs were used in 30 and three PAVMs, respectively. Inadvertent placement of one coil (n = 1) and pulmonary infarction (n = 1) occurred, but no relevant symptoms developed. For the 13 patients with available data, the mean arterial O2 saturation changed significantly from 92% to 98%. Complete or near-complete involution of the sac was observed in 30 of the 33 embolized PAVMs (91%). In these 33 embolized PAVMs, the mean sac diameter significantly decreased from 17.83 mm to 0.68 mm. CONCLUSION: Sporadic PAVMs are mostly the simple type with predominance in the lower lobe and peripheral locations. Transcatheter embolotherapy with coils or Amplatz vascular plugs is a safe and effective treatment for sporadic PAVMs and this provides excellent functional and radiological improvement.
Adolescent ; Adult ; Aged ; Arteriovenous Malformations/radiography/*therapy ; Child ; Cohort Studies ; Embolization, Therapeutic/*methods ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Artery/*radiography ; Pulmonary Veins/*radiography ; *Telangiectasia, Hereditary Hemorrhagic ; Tomography, X-Ray Computed/methods ; Treatment Outcome ; Young Adult

Adult ; Female ; Humans ; Pulmonary Veins ; abnormalities ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Varicose Veins ; complications ; diagnosis

Lemierre syndrome is a rare disease characterized by internal jugular vein thrombosis and septic emboli, and it primarily occurs in healthy young individuals; this disease usually follows an acute oropharyngeal infection. To the best of our knowledge, only a few reports about this disease have appeared in the radiologic literature. We report here the radiologic findings of a case of Lemierre syndrome in a young healthy female adolescent who had a history of acute pharyngotonsilitis. Chest radiographs showed lung nodules that displayed cavitary changes with rapid progression on the serial studies. High-resolution CT scan showed multi-focal patchy consolidations that connect with vessels, and this was suggestive of septic pulmonary embolism. Ultrasonography and CT scan of the neck revealed right internal jugular vein thrombosis.
Adolescent ; Humans ; Jugular Veins ; Lemierre Syndrome* ; Lung ; Neck ; Pulmonary Embolism ; Radiography, Thoracic ; Rare Diseases ; Thrombosis ; Tomography, X-Ray Computed ; Ultrasonography

A pulmonary embolism is a rare, but well described complication of percutaneous vertebroplasty; the majority of cases are caused by acrylic cement. Here, for the first time, we report a case of pulmonary embolism due to a thrombus in the right atrium, which was caused by an acrylic cement foreign body in the right atrium and central veins 6 years after percutaneous vertebroplasty. This case suggests that an acrylic cement foreign body should be considered as a potential source of thrombus formation in patients that develop a pulmonary embolism following percutaneous vertebroplasty.
Foreign Bodies* ; Heart Atria* ; Humans ; Pulmonary Embolism* ; Radiography, Interventional ; Thrombosis* ; Veins ; Vertebroplasty*