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The Pulmonary and Bronchial Vessels, Pulmonary Vascular Abnormalities including Embolism, Pulmonary and Bronchial Angiography, and A/V Malformations.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Tumours of the pulmonary artery (like tumours of the other great vessels or endocardium) are rare. Most are sarcomas of various types, but others may be chorioncarcinomas arising in the vessel wall (see refs.), occasionally benign tumours such as a chemodectoma may be seen (see below and also ps. 18.35 - 36). Most of the benign tumours arise in a main pulmonary artery and spread peripherally, retrograde spread into the right ventricle being less common. Secondary deposits in the brain, abdomen and lungs may occur. Occlusion of the pulmonary circulation with right ventricular outflow obstruction usually causes the clinical presentation.
Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Blood in the thoracic cavity may result from lung laceration or injury to any of the great vessels or the chest wall vasculature. Signs include reduced chest expansion, a dull percussion note and decreased air entry on the affected side, although these signs may not be easily detectable in the busy hospital resuscitation room. Most haemothoraces are probably now diagnosed on CT scanning. A supine chest radiograph may fail to identify a small or moderate quantity of blood in the hemithorax, as it will appear as diffuse shadowing instead of a distinct fluid level. An erect or semierect film should reveal blunting of the costophrenic angle and/or a fluid level. A haemothorax may coexist with a pneumothorax, in which case an air margin will also be seen on the affected side. Treatment is the insertion of a large-bore tube thoracostomy in the affected side.
Point-of-Care Ultrasound
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Carlos Augusto M. Menegozzo, Bruno M. Pereira
In relation to the great vessels, the inferior vena cava (IVC) will be evaluated to define its collapsibility during the breathing cycle and yield an estimate of intravascular volume – whether the patient will respond to volume infusion. The IVC view may be obtained by placing the curvilinear or phased array transducer longitudinally in the epigastric or right flank (like the e-FAST view) areas. The optimal view should display the IVC and the right atrium inlet. The identification of the ‘kissing walls’ sign (i.e. when the IVC collapses until its walls touch each other) should be interpreted as hypovolemia in an adequate clinical context, especially when the available cardiac windows corroborate this finding. Studies demonstrate a positive correlation between IVC measurements and central venous pressure (CVP). IVC measurements are better performed using the M-mode to identify the inspiratory and expiratory phases of ventilation. It is important to complement the IVC evaluation with a horizontal view of the vessel to avoid underestimation due to cylinder effect. The collapsibility index is calculated dividing the IVC diameter during inspiration and by its diameter during expiration. Roughly, ≤2 cm IVC with ≥50% collapsibility correlates with a CVP of less than 10 mmHg. When the IVC diameter is ≥2 cm displaying <50% collapse during inspiration, the estimated CVP is higher than 10 mmHg. These measurements may also be used to monitor clinical response to treatment.
Clinical, radiologic, and physiologic features of idiopathic pulmonary fibrosis (IPF) with and without emphysema
Published in Expert Review of Respiratory Medicine, 2022
Chenfei Li, Yan Wang, Qi Liu, Hai Zhang, Fei Xu, Zhenyun Gao, Xiaohui Wang, Guangyu Tao, Yuqing Chen, Wenwen Rong, Hong Yu, Feng Li
Lung image analysis was evaluated semi-quantitatively by two observers at (1) the origin of the great vessels, (2) the carina, (3) the pulmonary venous confluence, (4) between levels 3 and 5, and (5) 1 cm above the right hemidiaphragm. Pulmonary fibrosis coarseness was graded as follows [16]: 0) ground-glass opacification alone; 1) fine intralobular fibrosis; 2) microcystic honeycombing (air spaces up to 4 mm in diameter); 3) macrocystic honeycombing (air spaces greater than 4 mm in diameter). The five section scores were summed to give a 16-point coarseness score (0–15). Lung density and lung volume were measured by a lung volume reduction surgery evaluation system software (Dexin Medical Imaging Technology, Shanxi Weinan, China) according to a previous study [17,18], in which regions <-950 HU were defined as the emphysema area, −700 HU~-950 HU were defined as the normal lung tissue, and >-700HU were defined as pulmonary fibrosis. The extent of emphysema and fibrosis in lung tissue was expressed as percent emphysema and percent fibrosis respectively, and the extent of overall lung destruction (OLD) in lung tissue was expressed as the sum of percent emphysema and percent fibrosis.
Pericardial Anatomy, Interventions and Therapeutics: A Contemporary Review
Published in Structural Heart, 2021
Reza Reyaldeen, Nicholas Chan, Saberio Lo Presti, Agostina Fava, Chris Anthony, E. Rene Rodriguez, Carmela D. Tan, Walid Saliba, Paul C Cremer, Allan L. Klein
The parietal pericardium becomes continuous with the visceral pericardium at the bases of the great vessels including the vena cava and the pulmonary veins. These pericardial reflections occur at two locations: superiorly, surrounding the aorta, and pulmonary trunk; and more posteriorly surrounding the veins – the superior and inferior vena cava as well as the pulmonary veins. This means that the anterior, apical and lateral surfaces of the ventricles are freely accessible.5 A passage between the two sites of reflected serous pericardium is the transverse pericardial sinus, which lies posterior to the ascending aorta and the pulmonary trunk, anterior to the superior vena cava, and superior to the left atrium5 (Figure 2). The transverse sinus extends superiorly on the right side forming the superior aortic recess between the ascending aorta and superior vena cava1,5 (Figure 3). At the left superior aspect, is the ligament of Marshall and left atrial appendage at the entrance of the transverse sinus, relevant for epicardial-based appendage occlusion procedures. The zone of reflection surrounding the pulmonary veins is in the shape of an inverted ‘U’ and the cul-de-sac formed with the ‘U,’ posterior to the left atrium, is the oblique pericardial sinus, which is directly adjacent to the carina and esophagus posteriorly.1,5
Three-dimensional virtual and printed models for planning adult cardiovascular surgery
Published in Acta Cardiologica, 2021
Raul A. Borracci, Luis M. Ferreira, José M. Alvarez Gallesio, Osvaldo M. Tenorio Núñez, Michel David, Eduardo P. Eyheremendy
Solid opaque material (polylactic acid), monochromatic or in two colours, was used to replicate hard tissues such as calcifications (Figure 5) or vascular thrombi and tumours. Three-dimensional printed whole heart models seemed to be particularly useful for understanding the relationships between normal and pathological structures. Whole heart models were built in two formats: (1) replicating the external surface of the organs, and (2) reproducing the blood volume inside the heart chambers (blood pool) (Figure 6). Replicas of external structures reproduced the surface anatomy of the epicardium, epicardial coronary vessels, and great vessel surfaces; conversely, blood volume replicated the content of heart chambers and vessels. In these cases, endocavitary tumours and thrombi were seen as a lack of material. Although replicas of isolated heart chambers and great vessels facilitated manual instrumentation of endovascular devices and probes within structures, replicas of the entire anatomy of the heart were better at recognising neighbouring structures and providing a complete perspective of the organ and its relationships as a whole.