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A patient with previous catheter ablation therapy for atrial fibrillation was examined for an abnormal shadow on a chest radiograph. ECG-gated multidetector CT clearly showed the left upper pulmonary vein connected with the left inferior pulmonary vein. We hypothesize an intrapulmonary venous connection as a collateral.

This study investigated retrospectively the diagnostic yield and complication rate of transthoracic needle biopsies for posterior thoracic pulmonary lesions using C-arm cone-beam computed tomography CBCT. The risk factors for pulmonary hemorrhage were evaluated. Our study included 113 patients with 113 posterior pulmonary lesions mean longest diameter: 30.6 mm, and mean depth: 4.7 mm through the erector spinal muscles using a 19 / 20-gauge coaxial system. The diagnostic performances of procedures for malignant lesions and the incidence of complications after biopsies were also assessed. The patient-related and procedure-related variables were investigated. Risk factors for pulmonary hemorrhage were analyzed with a multivariate logistic regression analysis. Findings revealed 99 malignant, 13 benign, and one intermediate lesion. Sensitivity, speci city, and diagnostic accuracy rates were 100 99 / 99 , 92.3 12 / 13 , and 99.1 111 / 112 , respectively. Air embolization, hemothorax, hemoptysis, pneumothorax, and pulmonary hemorrhage, occurred in 0, 2, 12, 48, and 70 procedures. The averaged spinous process-pleura depth and the traversed lung parenchyma depth achieved by the introducer needles were 54.2 mm and 27.4 mm, respectively. The needle position at the pleural puncture site within the intercostal space was in middle 31 and inferior 69 areas. The incidence of pulmonary hemorrhage was significantly higher in smaller lesions p 0.001. Manual evacuation was performed in ve procedures for patients with pneumothorax. The chest tube placement trocar 8 Fr was performed in two procedures in patients with hemothorax and pneumothorax. In conclusion, the biopsy method with a posterior intercostal approach for posterior thoracic pulmonary lesions yielded high diagnostic accuracy and few major complications.

We examined whether the superior margin of the left main bronchus is the best landmark for the starting position of computed tomography coronary angiography CTCA . We retrospectively evaluated 693 consecutive CTCAs. From the scout scanogram, the superior margin of the left main bronchus was noted. The relationships among and distance between the superior margin of the left main bronchus and the left coronary system were analyzed. The superior margin of the left main bronchus extended caudally to the superior margin of the left coronary system in 13 patients 1.9 . The addition of 1 cm to the superior margin of the left main bronchus kept it caudal to the superior margin of the left coronary system in only one patient 0.1 . On the scout scanogram, 1 cm above the superior margin of the left main bronchus is the most appropriate starting position for CTCA.

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