Data on prevalence of portopulmonary shunts (PPS) are quite limited. Most studies have used cineportography or echocardiography for diagnosis. Only few recent case reports have reported the use of computed tomography (CT) for identification of PPS. This study tried to determine the prevalence of PPS in patients with cirrhosis using contrast-enhanced CT of the abdomen, and to determine their association with demographic and clinical characteristics.A total of 150 subjects with cirrhosis who had previously undergone triple-phase CT were analyzed. PPS was diagnosed when at least one esophageal varix met all of the following criteria: (i) it could be followed cephalad into the chest to the level of the inferior pulmonary vein or left atrium; (ii) it abutted the wall of either of these structures; (iii) it had luminal continuity with one of these structures; and (iv) it was no longer seen one slice above the level of contact.Of 150 subjects, 18 were excluded for incomplete data. The prevalence of PPS was found to be 26/132 (19.7%). Of these, 14 (53.8%) patients had PPS draining into the left atrium and 12 (46.2%) had those draining into one of the pulmonary veins. Presence of PPS was associated with the presence of varices at endoscopy, ascites, thrombocytopenia and splenomegaly.In our study, the largest study on PPS to date, the prevalence of PPS in cirrhotic patients using triple phase CT was found to be 19.7%. CT may be a useful technique to study PPS and their clinical implications.
Carcinosarcoma is an uncommon mixed tumor of the lung. We present the case of a 65 year-old-male with a cough and right lower lobe radio-opacity who underwent resection, showing a large endobronchial tumor with an epithelial component of non-small cell carcinoma and malignant mesenchymal elements. The radiologic and histopathologic features are reviewed with reference to relevant literature.
Advanced cardiac imaging is a valuable method to investigate cardiac malformations. The detection of the interventricular membranous septum has clinical significance due to thrombogenic and arrythmogenic predisposition, as well as a role in obstructing the pulmonary flow. This review describes six clinical presentations in which advanced cardiac imaging has been the tool for evaluation, with special emphasis in CT angiography and cardiac MRI sequences. Teaching Points • The interventricular membranous septum can predispose patients to thrombogenic and arrythmogenic events. • Subpulmonic stenosis relates to the protrusion of the aneurysm into the right ventricle • During surgery, ventricular pressures of the opened heart become balanced, making the aneurysm less evident.
Pleural malignant mesothelioma is an uncommon tumour of the thorax. We report two cases: a patient with atypically isolated location of the tumour at the right hilum and a young female patient. The histopathological and radiological features are reviewed with reference to relevant literature.
A 14-month-old girl with pentalogy of Cantrell, a very rare congenital syndrome characterized by an epigastric omphalocele and malformations of the heart, sternum, pericardium, and diaphragm, underwent echocardiography and multidetector computed tomography before surgical repair of these deformities was attempted. These tests revealed multiple cardiovascular and noncardiovascular abnormalities. After surgery, the patient's cardiovascular status was stable. Although studies have shown that echocardiography, multidetector computed tomography, and magnetic resonance imaging may each play a role in the diagnosis and management of this condition, there are few data available to support the use of one imaging modality over another.
The effects of hyperpnea on parenchymal lung mechanics are unknown, but they may contribute to the resultant airflow limitation commonly seen in asthma. To investigate these effects, we measured the following parameters in seven asthmatic and six normal subjects before and after 5 min of hyperpnea: specific conductance, upstream resistance, static compliance, the coefficient of retraction, lung volumes, lung hysteresis, and the ratio of maximal to partial flow rates (the M:P ratio, an indicator of the effect of deep inhalation on airflow, and a measure of relative airway and parenchymal hysteresis). In addition to a central effect on the airways, as shown by significant falls in specific conductance, hyperpnea in asthmatics, but not in normal subjects, resulted in significant increases in residual volume and pressure-volume hysteresis, suggestive of changes in parenchymal lung mechanics. The M:P ratio also increased in the asthmatics, consistent with greater increases in airway than in parenchymal hysteresis after hyperpnea. We conclude that hyperpnea has significant effects on the lung parenchyma that contribute to airflow limitation in asthmatics, and we hypothesize that these effects may be due to alterations in peripheral airway smooth muscle tone and surfactant function.
