Cargando…

Proximal Interruption of Pulmonary Artery: Spectrum of Radiological Findings With Emphasis on Chest Radiograph and Contrast-Enhanced Computed Tomography (CECT)

Introduction Proximal interruption of pulmonary artery (PIPA) is a congenital anomaly presenting with aberrant termination of the pulmonary artery at the hilum. It results in a variety of radiological and clinical manifestations. Clinically, isolated PIPA can be asymptomatic till late adulthood or c...

Descripción completa

Detalles Bibliográficos
Autores principales: Kollu, Raja, Uligada, Seema, Kotamraju, Sai, Nethi Balingari, Bhavana Lakshmi, Dudekula, Anees, Kumar, Prashanth, Patil, Chandrashekar, Gaddalay, Shubham, Gaddalay, Saumya L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9873200/
https://www.ncbi.nlm.nih.gov/pubmed/36699783
http://dx.doi.org/10.7759/cureus.32916
_version_ 1784877551615737856
author Kollu, Raja
Uligada, Seema
Kotamraju, Sai
Nethi Balingari, Bhavana Lakshmi
Dudekula, Anees
Kumar, Prashanth
Patil, Chandrashekar
Gaddalay, Shubham
Gaddalay, Saumya L
author_facet Kollu, Raja
Uligada, Seema
Kotamraju, Sai
Nethi Balingari, Bhavana Lakshmi
Dudekula, Anees
Kumar, Prashanth
Patil, Chandrashekar
Gaddalay, Shubham
Gaddalay, Saumya L
author_sort Kollu, Raja
collection PubMed
description Introduction Proximal interruption of pulmonary artery (PIPA) is a congenital anomaly presenting with aberrant termination of the pulmonary artery at the hilum. It results in a variety of radiological and clinical manifestations. Clinically, isolated PIPA can be asymptomatic till late adulthood or can present with dyspnoea, chest discomfort, hemoptysis and recurrent infections. PIPA can be associated with multiple cardiovascular anomalies such as tetralogy of Fallot (TOF), ventricular septal defects (VSD), and scimitar syndrome. We present a spectrum of cases with both isolated proximal interruption of the pulmonary artery and cases associated with other cardiovascular abnormalities. Typical chest radiographs and chest contrast-enhanced computed tomography (CECT) findings are discussed and demonstrated in detail. Proper and early diagnosis is a crucial step as it can significantly modify the treatment choice, thereby reducing morbidity. Objective To document the different presentations of the proximal arrest of pulmonary arteries, to document associations with cardiovascular and pulmonary manifestations, and to elaborate on and demonstrate the various radiological imaging findings. Material and methods All the cases that were reported with proximal interruption of pulmonary artery on the CECT studies conducted between 2019 and 2022 at a tertiary care hospital in Telangana, India. The demographic data, clinical presentation, chest radiographs, and chest CECT were collected retrospectively. Data analysis was done using Microsoft Excel 2019 to calculate descriptive statistics. A total of 22 cases were identified of which three cases were excluded of as they were previously operated and 19 cases were taken as the study population. Results Nineteen patients were included in the study. Demographic details, clinical history, CECT, and chest radiographs were collected wherever available. The majority of the cases belonged to the ≤ 10 yrs age group with the most common clinical presentation being a previous diagnosis of tuberculosis or recurrent upper respiratory tract infections. The predominant findings on chest radiographs were deviation of the trachea to the affected side, volume loss in the ipsilateral lung field, and compensatory hyperinflation of the contralateral lung field. On the CECT chest, the main findings were interrupted pulmonary artery, hypoplastic lung fields with bronchiectasis, or ground glassing. Associated cardiovascular and pulmonary malformations were identified with notable cases: TOF, right-sided aortic arch and scimitar syndrome. Their typical imaging findings have been elucidated and discussed in detail. Conclusions Patients with recurrent respiratory infections or hemoptysis having hypoplastic lung field with hyperinflation of the contralateral lung on chest radiographs should be evaluated for pulmonary artery interruptions. Chest CECT allows evaluation of the bronchial tree and lung parenchyma at the same time which helps distinguish pulmonary interruption from conditions such as Swyer-James-Macleod syndrome, pulmonary hypoplasia, thromboembolism and arteritis. Cases with PIPA can also be associated with cardiovascular and pulmonary anomalies such as TOF, partial anomalous pulmonary venous connection (PAPVC), and VSD. The knowledge of these associations is essential as they can influence the mode of treatment and can help reduce the long-term morbidity and mortality associated with the condition.
format Online
Article
Text
id pubmed-9873200
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-98732002023-01-24 Proximal Interruption of Pulmonary Artery: Spectrum of Radiological Findings With Emphasis on Chest Radiograph and Contrast-Enhanced Computed Tomography (CECT) Kollu, Raja Uligada, Seema Kotamraju, Sai Nethi Balingari, Bhavana Lakshmi Dudekula, Anees Kumar, Prashanth Patil, Chandrashekar Gaddalay, Shubham Gaddalay, Saumya L Cureus Cardiac/Thoracic/Vascular Surgery Introduction Proximal interruption of pulmonary artery (PIPA) is a congenital anomaly presenting with aberrant termination of the pulmonary artery at the hilum. It results in a variety of radiological and clinical manifestations. Clinically, isolated PIPA can be asymptomatic till late adulthood or can present with dyspnoea, chest discomfort, hemoptysis and recurrent infections. PIPA can be associated with multiple cardiovascular anomalies such as tetralogy of Fallot (TOF), ventricular septal defects (VSD), and scimitar syndrome. We present a spectrum of cases with both isolated proximal interruption of the pulmonary artery and cases associated with other cardiovascular abnormalities. Typical chest radiographs and chest contrast-enhanced computed tomography (CECT) findings are discussed and demonstrated in detail. Proper and early diagnosis is a crucial step as it can significantly modify the treatment choice, thereby reducing morbidity. Objective To document the different presentations of the proximal arrest of pulmonary arteries, to document associations with cardiovascular and pulmonary manifestations, and to elaborate on and demonstrate the various radiological imaging findings. Material and methods All the cases that were reported with proximal interruption of pulmonary artery on the CECT studies conducted between 2019 and 2022 at a tertiary care hospital in Telangana, India. The demographic data, clinical presentation, chest radiographs, and chest CECT were collected retrospectively. Data analysis was done using Microsoft Excel 2019 to calculate descriptive statistics. A total of 22 cases were identified of which three cases were excluded of as they were previously operated and 19 cases were taken as the study population. Results Nineteen patients were included in the study. Demographic details, clinical history, CECT, and chest radiographs were collected wherever available. The majority of the cases belonged to the ≤ 10 yrs age group with the most common clinical presentation being a previous diagnosis of tuberculosis or recurrent upper respiratory tract infections. The predominant findings on chest radiographs were deviation of the trachea to the affected side, volume loss in the ipsilateral lung field, and compensatory hyperinflation of the contralateral lung field. On the CECT chest, the main findings were interrupted pulmonary artery, hypoplastic lung fields with bronchiectasis, or ground glassing. Associated cardiovascular and pulmonary malformations were identified with notable cases: TOF, right-sided aortic arch and scimitar syndrome. Their typical imaging findings have been elucidated and discussed in detail. Conclusions Patients with recurrent respiratory infections or hemoptysis having hypoplastic lung field with hyperinflation of the contralateral lung on chest radiographs should be evaluated for pulmonary artery interruptions. Chest CECT allows evaluation of the bronchial tree and lung parenchyma at the same time which helps distinguish pulmonary interruption from conditions such as Swyer-James-Macleod syndrome, pulmonary hypoplasia, thromboembolism and arteritis. Cases with PIPA can also be associated with cardiovascular and pulmonary anomalies such as TOF, partial anomalous pulmonary venous connection (PAPVC), and VSD. The knowledge of these associations is essential as they can influence the mode of treatment and can help reduce the long-term morbidity and mortality associated with the condition. Cureus 2022-12-25 /pmc/articles/PMC9873200/ /pubmed/36699783 http://dx.doi.org/10.7759/cureus.32916 Text en Copyright © 2022, Kollu et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiac/Thoracic/Vascular Surgery
Kollu, Raja
Uligada, Seema
Kotamraju, Sai
Nethi Balingari, Bhavana Lakshmi
Dudekula, Anees
Kumar, Prashanth
Patil, Chandrashekar
Gaddalay, Shubham
Gaddalay, Saumya L
Proximal Interruption of Pulmonary Artery: Spectrum of Radiological Findings With Emphasis on Chest Radiograph and Contrast-Enhanced Computed Tomography (CECT)
title Proximal Interruption of Pulmonary Artery: Spectrum of Radiological Findings With Emphasis on Chest Radiograph and Contrast-Enhanced Computed Tomography (CECT)
title_full Proximal Interruption of Pulmonary Artery: Spectrum of Radiological Findings With Emphasis on Chest Radiograph and Contrast-Enhanced Computed Tomography (CECT)
title_fullStr Proximal Interruption of Pulmonary Artery: Spectrum of Radiological Findings With Emphasis on Chest Radiograph and Contrast-Enhanced Computed Tomography (CECT)
title_full_unstemmed Proximal Interruption of Pulmonary Artery: Spectrum of Radiological Findings With Emphasis on Chest Radiograph and Contrast-Enhanced Computed Tomography (CECT)
title_short Proximal Interruption of Pulmonary Artery: Spectrum of Radiological Findings With Emphasis on Chest Radiograph and Contrast-Enhanced Computed Tomography (CECT)
title_sort proximal interruption of pulmonary artery: spectrum of radiological findings with emphasis on chest radiograph and contrast-enhanced computed tomography (cect)
topic Cardiac/Thoracic/Vascular Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9873200/
https://www.ncbi.nlm.nih.gov/pubmed/36699783
http://dx.doi.org/10.7759/cureus.32916
work_keys_str_mv AT kolluraja proximalinterruptionofpulmonaryarteryspectrumofradiologicalfindingswithemphasisonchestradiographandcontrastenhancedcomputedtomographycect
AT uligadaseema proximalinterruptionofpulmonaryarteryspectrumofradiologicalfindingswithemphasisonchestradiographandcontrastenhancedcomputedtomographycect
AT kotamrajusai proximalinterruptionofpulmonaryarteryspectrumofradiologicalfindingswithemphasisonchestradiographandcontrastenhancedcomputedtomographycect
AT nethibalingaribhavanalakshmi proximalinterruptionofpulmonaryarteryspectrumofradiologicalfindingswithemphasisonchestradiographandcontrastenhancedcomputedtomographycect
AT dudekulaanees proximalinterruptionofpulmonaryarteryspectrumofradiologicalfindingswithemphasisonchestradiographandcontrastenhancedcomputedtomographycect
AT kumarprashanth proximalinterruptionofpulmonaryarteryspectrumofradiologicalfindingswithemphasisonchestradiographandcontrastenhancedcomputedtomographycect
AT patilchandrashekar proximalinterruptionofpulmonaryarteryspectrumofradiologicalfindingswithemphasisonchestradiographandcontrastenhancedcomputedtomographycect
AT gaddalayshubham proximalinterruptionofpulmonaryarteryspectrumofradiologicalfindingswithemphasisonchestradiographandcontrastenhancedcomputedtomographycect
AT gaddalaysaumyal proximalinterruptionofpulmonaryarteryspectrumofradiologicalfindingswithemphasisonchestradiographandcontrastenhancedcomputedtomographycect