The Teaching Point

Filling defects in the pulmonary artery have many differential diagnoses other than pulmonary embolism. If the filling defect in the pulmonary artery has unusual appearance (extending to the more proximal left pulmonary artery or curvilinear appearance), and especially if this is happening in the setting of underlying chronic parenchymal lung disease, possibility of systemic to pulmonary artery shunt should be raised. 4D CTA (time-resolved CTA) can be used as a non-invasive and effective tool for reaching to this diagnosis. Its ability to provide detailed anatomy and multiplanar reconstruction could aid interventional radiologist in treatment planning.






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From the manuscript

Unusual Pulmonary Arterial Filling Defect caused by Systemic to Pulmonary Shunt in the Setting of Chronic Lung Disease Demonstrated by Dynamic 4D CTA

Free full text article: Unusual Pulmonary Arterial Filling Defect caused by Systemic to Pulmonary Shunt in the Setting of Chronic Lung Disease Demonstrated by Dynamic 4D CTA

Abstract
Even though pulmonary embolism is by far the most common cause of filling defect in the pulmonary arterial system, other less common etiologies should be considered especially in the setting of atypical clinical scenario or unusual imaging findings. Unusual pattern of filling defect in the pulmonary artery in the setting of chronic inflammatory/fibrotic parenchymal lung disease should raise the concern for systemic to pulmonary artery shunt. This diagnosis is typically made by conventional angiography. Dynamic 4D CT angiography however can be a safe, noninvasive and effective alternative tool for making such a diagnosis. It has the added value of multiplanar reconstruction capabilities and providing detailed anatomy which can be vital for interventional radiologists when planning their approach for possible intervention. We present 2 cases of such shunts, and illustrate the demonstration of these shunts by using dynamic 4D CT angiography.






References



1. Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard JA, McLoud TC. CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics 2004 Sep-Oct; 24(5):1219-38
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


2. Anderson FA Jr, Wheeler B, Goldberg RJ, Hosmer DW, Patwardhan NA. A population-based perspective of the hospital incidence and case fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT study. Arch Intern Med 1991; 151:933-938
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


3. Giuntini C, Ricco GD, Marini C, Melillo E, Palla A. Pulmonary embolism: epidemiology. Chest 1995; 107(suppl): 3S-9S
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


4. Yoon W, Kim JK, Kim YH, Chung TW, Kang HK. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review. Radiographics 2002; 22:1395-409
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


5. Riehl G, Chaffanjon P, Frey G, Sessa C, Brichon PY. Postoperative systemic artery to pulmonary vessel fistula: analysis of three cases. Ann Thorac Surg 2003 Dec; 76(6):1873-7
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


6. Jamshidi P, Ghaffari S, Mahmoodi K. Transpulmonary closing of left internal mammary artery to pulmonary artery fistula with polytetrafluoroethylene covered stent: a case report and review of literature.Cardiol J. 2009; 16(5):469-72
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


7. Saito T, Matsuda M, Yamaguchi T, Matsuzaki T, Nakagawa S. A case of a traumatic systemic-pulmonary arteriovenous fistula. Jpn Heart J 1975;16:196-203.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


8. Bendszus M, Koltzenburg M, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L. Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study. Lancet 1999; 354:1594-1597
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


9. Klingebiel R, Siebert E, Diekmann S, Wiener E, Masuhr F, Wagner M. 4-D imaging in cerebrovascular disorders by using 320-slice CT: feasibility and preliminary clinical experience. Acad Radiol 2009; 16:123-9
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


10. Siebert E, Bohner G, Dewey M, Masuhr F, Hoffmann KT, Mews J. 320-slice CT neuroimaging: initial clinical experience and image quality evaluation. Br J Radiol 2009; 82:561-70
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


11. Willems PW, Taeshineetanakul P, Schenk B, Brouwer PA, Terbrugge KG, Krings T. The use of 4D-CTA in the diagnostic work-up of brain arteriovenous malformations. Neuroradiology 2012; 54:123-31
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


12. Stein PD, Chenevert TL, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Jablonski KA, Leeper KV Jr, Naidich DP, Sak DJ, Sostman HD, Tapson VF, Weg JG, Woodard PK. PIOPED III (Prospective Investigation of Pulmonary Embolism Diagnosis III) Investigators. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III) Ann Intern Med
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


13. Lee JK1, Park JH, Kim J, Kim SJ, Lee AR, Lee CH, So YH. Embolization of multiple systemic artery to pulmonary artery fistula with recurrent hemoptysis. Tuberc Respir Dis 2013;75:120-4
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


14. Yamada Y, Imamura H, Amamoto Y, Ochi M, Nagano K, Ito M. Congenital internal mammary artery-to-pulmonary artery fistulas: a case report. Heart Vessels 1987;3:47-9.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


15. Han D, Lee KS, Franquet T, Müller NL, Kim TS, Kim H, Kwon OJ, Byun HS. Thrombotic and nonthrombotic pulmonary arterial embolism: spectrum of imaging findings. Radiographics 2003 ; 23:1521-39.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


16. Castañer E, Gallardo X, Ballesteros E, Andreu M, Pallardó Y, Mata JM, Riera L. CT diagnosis of chronic pulmonary thromboembolism. Radiographics 2009;29:31-50.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine




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1. Shunt

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3. chronic lung disease

4. dynamic CT

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