pulmonary artery aneurysm

肺动脉瘤
  • 文章类型: Case Reports
    肺动脉动脉瘤被定义为肺动脉的局部扩张>正常上限的1.5倍或测量4cm的肺动脉。肺动脉瘤被认为是一种罕见的疾病,在14,000次验尸中发病率为1。
    方法:下面是一个28岁绅士的案例,表现为劳力性呼吸困难和端坐呼吸,并在计算机断层扫描时被诊断出由主肺动脉引起的76cm×56cm×53cm的肺动脉瘤,根据现有文献,这是罕见的发现。
    肺动脉瘤的临床表现各不相同,很少发生。然而,放射成像的使用有助于诊断。然而,文献中还没有提到具体的治疗指南,医疗管理,手术切除和血管内治疗是多种选择之一.
    结论:肺动脉动脉瘤表现出非特异性症状,这使得医生的诊断非常具有挑战性,在过程中,延迟疾病的准确管理。然而,必须将肺动脉瘤视为鉴别诊断和适当的治疗方案,无论是医疗还是手术,都应该选择记住疾病的大小和并发症。
    UNASSIGNED: Pulmonary Artery Aneurysm is defined as the localized dilation of the pulmonary artery >1.5 times the upper normal limit or pulmonary artery measuring 4 cm. Pulmonary artery aneurysm is considered as a rare disorder having an incidence of 1 in 14,000 post-mortem examinations.
    METHODS: Presented below is a case of a 28 year old gentleman, who presented with exertional dyspnea and orthopnea and was diagnosed with having a pulmonary artery aneurysm of 76 cm × 56 cm × 53 cm arising from the main pulmonary artery upon Computed Tomography Scan which is a rare finding according to the available literature.
    UNASSIGNED: Clinical manifestations of pulmonary artery aneurysm are varying and rarely occur. However the use of radiological imaging has aided in the diagnosis. No specific treatment guidelines have been mentioned yet in the literature however, medical management, surgical resection and endovascular therapy are one of the multiple options available.
    CONCLUSIONS: Pulmonary Artery Aneurysm presents with non-specific symptoms which makes the diagnosis very challenging for the physicians, in process, delaying the accurate management of the disease. However, pulmonary artery aneurysm must be considered as a differential diagnosis and appropriate management options, whether medical or surgical should be opted for keeping in mind the size and the complications of the disease.
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  • 文章类型: Case Reports
    胸内器官破裂的心脏压塞可导致心脏猝死。在极少数情况下,肺动脉可能是心包积血的来源。我们描述了一个62岁的女性,没有明显的既往病史,他突然意外死亡。法医尸检显示500毫升心包血。进一步解剖显示肺动脉干有囊状动脉瘤,连同先前解剖的证据,即,新内膜层。还存在持续性动脉导管(PDA)。肺动脉瘤(PAA)很少见,通常与先天性心脏病(CHD)有关。PDA是与PAA相关的最常见的CHD。继发性肺动脉高压使肺动脉容易发生内侧变性,并增加夹层和破裂的风险。仔细检查大血管和先天性异常在法医尸体解剖中对于猝死调查至关重要。
    Cardiac tamponade from ruptured intrathoracic organs can lead to sudden cardiac death. In rare circumstances, the pulmonary artery can be the source of hemopericardium. We describe a case of a 62-year-old woman with no significant past medical history, who presented with sudden unexpected death. A forensic autopsy revealed 500 ml of hemopericardium. Further dissection demonstrated a saccular aneurysm in the pulmonary artery trunk, along with the evidence of prior dissection, i.e., neointimal layer. Persistent ductus arteriosus (PDA) was also present. Pulmonary artery aneurysms (PAA) are rare and often associated with congenital heart disease (CHD). PDA is the most common CHD related to PAA. Secondary pulmonary hypertension makes the pulmonary artery vulnerable to medial degeneration and increases the risk of dissection and rupture. Careful inspection of the great vessels and congenital anomalies are essential in the forensic autopsies for sudden death investigation.
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  • 文章类型: Journal Article
    肺动脉瘤(PAA)是一种罕见的肺血管异常。它可以是特发性或继发于各种病理,经常有多种因素导致其形成。我们报告了一例伴有结节病和PAA的男子。
    一名诊断为肺结节病的75岁男性因左心室射血分数(LVEF)降低的心力衰竭被转诊到心脏科。经胸超声心动图显示LVEF轻度降低,主动脉根部和肺动脉(PA)扩张,没有肺动脉高压(PH)的迹象。进行了心脏磁共振成像,显示轻度左心室扩张,LVEF为40%,主要PA扩张(43毫米)和钆晚期增强模式提示心脏结节病。在后续行动中,胸部计算机断层扫描(CT)血管造影扫描显示升主动脉扩张和巨大的主PA动脉瘤(60mm)。进行了右心导管插入术,并且获得34mmHg的平均PA压力。鉴于临床背景,患者被认为是由于肺部疾病和左心疾病导致的PH,结节病可能是血管肉芽肿累及PAA。
    PAA是一种罕见的发现,主要发生在PH的设置中。结节病是一种肉芽肿性疾病,主要影响肺部,但是已经描述了大血管的结节病。在这个临床病例中,PA脆性导致动脉瘤形成的可能原因仍然是结瘤样血管浸润,关于PA尺寸和轻度升高的PA压力之间的差异。
    结论:肺动脉瘤是一种罕见的肺血管异常,可以是特发性或肺动脉高压的结果,先天性心脏病,感染,血管炎或胶原病。由于这种疾病的发病率低,它的诊断没有指导方针,管理或后续行动,治疗是基于潜在的病因,动脉瘤的尺寸和症状的发生。结节病是一种病因不明的多系统疾病,其特征是主要累及肺部的非干酪样肉芽肿。但也会影响皮肤,眼睛,和淋巴结。很少描述大血管的结节病参与。
    UNASSIGNED: Pulmonary artery aneurysm (PAA) is a rare abnormality of pulmonary vasculature. It can be idiopathic or secondary to various pathologies, frequently with multiple factors leading to its formation. We report the case of a man with concomitant sarcoidosis and PAA.
    UNASSIGNED: A 75-year-old male with a diagnosis of pulmonary sarcoidosis was referred to the Cardiology department due to heart failure with reduced left ventricular ejection fraction (LVEF). The transthoracic echocardiogram revealed mildly reduced LVEF, aortic root and pulmonary artery (PA) dilatation, and no signs of pulmonary hypertension (PH). Cardiac magnetic resonance imaging was performed, revealing mild left ventricular dilation, LVEF of 40%, main PA dilation (43 mm) and a pattern of late gadolinium enhancement suggestive of cardiac sarcoidosis. At follow-up, a thoracic computed tomography (CT) angiography scan revealed ascending aorta ectasia and giant main PA aneurysm (60 mm). A right heart catheterisation was performed, and a mean PA pressure of 34 mmHg was obtained. Given the clinical context, the patient was considered to have PH due to lung disease and left heart disease, and PAA was possible due to vascular granulomatous involvement by sarcoidosis.
    UNASSIGNED: PAA is a rare finding and mostly occurs in the setting of PH. Sarcoidosis is a granulomatous disease that mostly affects the lungs, but the sarcoid involvement of great vessels has been described. In this clinical case, the probable cause for the PA fragility leading to aneurysm formation remains sarcoid vascular infiltration, regarding the discrepancy between the PA dimensions and mildly elevated PA pressure.
    CONCLUSIONS: Pulmonary artery aneurysm is a rare abnormality of pulmonary vasculature that can be idiopathic or a consequence of pulmonary hypertension, congenital heart disease, infection, vasculitis or collagenopathies.Due to the low incidence of this disease, there are no guidelines for its diagnosis, management or follow-up, and treatment is based on the underlying aetiology, aneurysm dimensions and occurrence of symptoms.Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granulomas that mostly involve the lungs, but can also affect skin, eyes, and lymph nodes. Sarcoid involvement of great vessels has been rarely described.
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  • 文章类型: Journal Article
    Behçet病是一种主要影响人体血管的慢性炎症,表现出各种临床表现和并发症。确切原因尚不清楚,但是遗传倾向,免疫反应,和血管活化被认为有助于其发展。这种疾病在某些地理区域更为普遍,主要影响年轻人,尤其是男性。肺动脉瘤,Behçet病的并发症,是导致白塞病死亡的主要原因.在这次审查中,我们总结了Behcet病的并发症,重点是肺动脉动脉瘤。我们讨论了医学,血管内,白塞病肺动脉瘤的外科治疗以及不同治疗方案的适应症和结果。皮质类固醇和环磷酰胺仍然是首选的一线治疗。然而,英夫利昔单抗或阿达木单抗的临床改善,肿瘤坏死因子-α(TNFα)阻断剂,在推荐的一线药物治疗失败后报告。在药物治疗失败或危及生命的咯血患者中,血管内或手术干预是下一个选择.血管内介入治疗包括用线圈或丙烯酸胶栓塞肺动脉并使用塞子,封堵器,或支架。血管内介入治疗通常比手术有更少的不良反应。尽管肺动脉动脉瘤的手术风险很高,这可能是危及生命的咯血患者的救命程序。手术选择,包括肺动脉结扎,动脉瘤缝合术,节段切除术,肺叶切除术,或肺切除术是可用的。然而,Behçet动脉瘤的手术治疗结果往往令人失望.
    Behçet\'s disease is a chronic inflammatory condition that predominantly affects the body\'s blood vessels, exhibiting various clinical manifestations and complications. The exact cause remains unclear, but genetic predisposition, immune responses, and vascular activation are believed to contribute to its development. This disease is more prevalent in certain geographic regions and primarily affects young adults, particularly males. Pulmonary aneurysm, a complication of Behçet\'s disease, is the leading cause of mortality in Behcet disease. In this review, we summarize the complications of Behcet disease with a focus on pulmonary artery aneurysms. We discussed the medical, endovascular, and surgical management of pulmonary aneurysms in Behcet disease and the indications and outcomes of the different treatment options. Corticosteroids and cyclophosphamide remain the preferred first-line therapy. However, clinical improvement with infliximab or adalimumab, tumor necrosis factor-alpha (TNFα) blocking agents, have been reported after treatment failure with recommended first-line agents. In patients who fail medical therapy or those with life-threatening hemoptysis, endovascular or surgical intervention is the next option. Endovascular interventions include pulmonary artery embolization with coils or acrylic glue and using plugs, occluders, or stents. Endovascular interventions usually have fewer adverse effects than surgery. Although the risk of surgical procedures is high in pulmonary artery aneurysms, it could be a life-saving procedure in patients with life-threatening hemoptysis. Surgical options, including pulmonary artery ligation, aneurysmorrhaphy, segmentectomy, lobectomy, or pneumonectomy are available. However, the results of surgical therapy for Behçet aneurysms are often disappointing.
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  • 文章类型: Journal Article
    背景:Behcet病(BD)是一种伴有动脉血管炎的慢性炎症性疾病。虽然,肺动脉瘤(PAA)被认为是典型的动脉疾病,最近的研究也报道了有或没有动脉瘤的肺动脉血栓形成(PAT)的增加.在这项研究中,我们旨在描述肺部受累的计算机断层扫描肺动脉造影(CTPA)发现及其与BD症状和急性期反应的相关性。
    方法:在这项回顾性研究中,由两名放射科医生评估了153例BD患者的CTPA。从患者档案中收集临床和实验室数据。肺动脉受累(PAI)定义为CT血管造影中的血栓或动脉瘤。
    结果:我们的大多数患者(85.6%)为男性,在血管造影评估期间,中位年龄为33.7±10岁。62例(40.5%)血管造影显示血栓:14次节段,29分段,13叶和主枝6。其中,82.3%(n=51)有双侧受累。在58例(93.5%)血管造影中存在孤立的PAT,只有4例(2.6%)血管造影显示动脉瘤和血栓。在9例血管造影中检测到肺梗死。四十四位(29.3%)病人,几乎所有人都接受了其他适应症的免疫抑制治疗,筛查无症状肺部受累(无任何症状或急性期反应(APR)增加),其中四分之一被诊断为有节段或亚节段PAT。
    结论:我们的结果表明,孤立性肺血栓形成是PAI的主要形式,在我们的BD病例中,孤立的肺动脉瘤形成很少见。在有或没有APR增加的肺部症状的情况下,肺段或更近端的肺动脉受累最常见。我们还观察到,PAI可能出现在约四分之一的男性BD患者中,没有症状或APR增加。我们的结果表明,有肺部症状的BD患者应该通过CTPA筛查PAI,然而,需要进一步的研究来阐明常规CTPA筛查在无症状BD患者中的作用.
    BACKGROUND: Behcet\'s disease (BD) is a chronic inflammatory disorder with arterial vasculitis. Although, pulmonary artery aneurysm (PAA) is accepted as the prototypic arterial disorder, an increasing presence of pulmonary artery thrombosis (PAT) with or without aneurysms was also reported in recent studies. In this study, we aimed to describe computed tomography pulmonary angiography (CTPA) findings of pulmonary involvement and its correlation with symptoms and acute phase response in BD.
    METHODS: In this retrospective study, 153 CTPA of BD patients were assessed by two radiologists. Clinical and laboratory data were collected from the patient files. Pulmonary artery involvement (PAI) was defined as thrombus or aneurysm in CT angiography.
    RESULTS: Most of (85.6 %) our patients were male and median age was 33.7 ± 10 years during angiographic assessments. Sixty-two (40.5 %) angiographies presented a thrombus: 14 subsegmental, 29 segmental, 13 lobar and 6 main branches. Among these, 82.3 % (n = 51) had bilateral involvement. Isolated PAT was present in 58 (93.5 %) angiographies with only 4 (2.6 %) angiographies displaying an aneurysm together with a thrombus. Pulmonary infarction was detected in 9 angiographies. Forty-four (29.3 %) patients, almost all of them under immunosuppressive treatments for other indications, were screened for asymptomatic pulmonary involvement (without any symptoms or increased acute-phase response (APR)), and one fourth of these were diagnosed as having a segmental or subsegmental PAT.
    CONCLUSIONS: Our results show that isolated pulmonary thrombosis is the main form of PAI, and isolated pulmonary aneurysm formation is rare in our BD cases. In the presence of pulmonary symptoms with or without increased APRs, involvement of segmental or more proximal parts of pulmonary arteries is most commonly detected. We also observed that PAI may be seen in about one fourth of especially male BD patients without symptoms or increased APR. Our results suggest that BD patients with pulmonary symptoms should be screened by CTPA for PAI, however, further research is needed to clarify the role of routine CTPA screening in asymptomatic BD patients.
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  • 文章类型: Case Reports
    肺动脉动脉瘤与缺血性心脏病的关联并不常见,其手术管理在文献中很少描述。手术干预应根据并存的疾病和合并症进行个体化,以达到最佳效果。我们报告了一例76岁的男性,其背景病史为缺血性心脏病所致的冠状动脉支架置入术。该患者由于巨大的肺动脉瘤而表现出冠状动脉压迫的特征。他接受了25mmHancock导管置换动脉瘤肺动脉干的手术。
    Association of Pulmonary Artery Aneurysm with Ischemic Heart Disease is uncommon, and its surgical management has been rarely described in the literature. Surgical intervention should be individualised according to the coexisting diseases and comorbidities to achieve optimal outcome. We report a case of a 76-year-old man with background history of coronary artery stenting due to ischaemic heart disease. The patient presented with features of coronary compression due to giant pulmonary artery aneurysm. He was operated with replacement of aneurysmal pulmonary trunk with 25 mm Hancock conduit.
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  • 文章类型: Journal Article
    在治疗肺脓肿期间,医生应考虑咯血患者的肺动脉瘤并发症。CT造影或血管造影可用于诊断,随后进行肺栓塞治疗。
    Physicians should consider a pulmonary artery aneurysm complication in patients presenting with hemoptysis during treatment for a pulmonary abscess. Contrast-enhanced CT or angiography is recommended for diagnosis, followed by pulmonary embolization for treatment.
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  • 文章类型: Journal Article
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  • 文章类型: Case Reports
    非结核分枝杆菌(NTM)感染有时会导致肺动脉瘤(PAA)的发展,一种罕见但危及生命的并发症.我们在此报告了一名64岁的女性,有NTM感染史,并伴有严重咯血。计算机断层扫描显示PAA破裂,经肺动脉栓塞成功治疗。随后进行右全肺切除术以控制感染。这种情况强调需要在出现咯血的NTM感染患者中考虑PAA。早期发现和适当的管理对于预防这种致命并发症至关重要。
    Nontuberculous mycobacterial (NTM) infection sometimes leads to the development of pulmonary artery aneurysm (PAA), a rare but life-threatening complication. We herein report a 64-year-old woman with a history of NTM infection who presented with severe hemoptysis. Computed tomography revealed a ruptured PAA, which was treated successfully with pulmonary artery embolization. Subsequent right total pneumonectomy was performed to control infection. This case emphasizes the need to consider PAA in patients with NTM infection who present with hemoptysis. Early detection and appropriate management are critical for preventing this fatal complication.
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  • 文章类型: Journal Article
    肺动脉瘤(PAA)是一种罕见的血管疾病,已知这是2019年冠状病毒病(COVID-19)感染后极其罕见的并发症。这种疾病的其他病因是癌症,先天性心脏异常,和血管炎.虽然它通常是一种无症状的疾病,PAA有时会出现严重的症状,例如由于动脉瘤破裂引起的咯血。
    这里,作者报告了一例75岁的女性患者出现咯血。当她被诊断患有COVID-19时,在之前的计算机断层扫描中,她的脉管系统正常。在接受COVID-19治疗四个月后,并进行了CT肺动脉造影辅助诊断,患者后来被诊断为PAA.
    PAAs具有广泛的非特异性症状。主要的诊断测试是计算机断层扫描血管造影。治疗仍然存在争议,在管理上没有明确的协议。
    COVID-19感染可对血管造成严重损害,特别是在其他可能进一步损害脉管系统的病因的情况下。该报告证明了患者随访和监测COVID-19感染后对减少进一步并发症和死亡率的重要性。
    Pulmonary artery aneurysm (PAA) is a rare vascular disease, and it is known to be an extremely rare complication following infection with the coronavirus disease 2019 (COVID-19). Other etiologies of the disease are cancer, congenital heart anomalies, and vasculitis. While it is usually an asymptomatic disease, PAA can sometimes present with severe symptoms such as hemoptysis due to the rupture of the aneurysm.
    UNASSIGNED: Here, The authors report a case of a 75-year-old female patient presented with hemoptysis. She had normal vasculature on a previous computed tomography scan when she was diagnosed with COVID-19. Four months after having COVID-19, and with a computed tomographic pulmonary angiography -assisted diagnosis, the patient was later diagnosed with PAA.
    UNASSIGNED: PAAs have a wide nonspecific range of symptoms. The main diagnostic test is computed tomography angiography. Treatment is still controversial with no definite agreement on the management.
    UNASSIGNED: COVID-19 infections can cause severe damage to blood vessels, especially in the context of other etiologies that can further damage the vasculature. This report demonstrates the importance of patient follow-up and monitoring post-COVID-19 infection in reducing further complications and mortality.
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