Abnormal Vascular Communications

Clark, Richard L.; Goldenberg, David B.; Blazek, James V.

doi:10.2214/ajr.107.2.413

“…However, it is sufficiently accurate for present purposes to presume that there was shunting from left to right in all. Experimental evidence has suggested that in some of the left to left shunts the communication with the systemic circulation may have been not in the pulmonary veins, but at precapillary level on the arterial side (Clark et al, 1969). Moreover, any clinical effects of the two groups of shunts may well be indistinguishable (Scott and Perry, 1969) in view of their haemodynamic similarity.…”

Section: Discussionmentioning

confidence: 99%

“…In two others open thoracotomy had been performed, with respectively, resection of a segment of the left lower lobe (Clark et al, 1969) and right upper and middle lobectomy ( Wolarsky and Humphreys, 1970). In the case documented by Akatsuka et al (1974), artificial pneumothorax therapy for pulmonary tuberculosis preceded the development of an extensive vascular anomaly of the thoracic parietes fed by systemic arteries and involving the shunting of systemic blood to the pulmonary circulation.…”

Section: Introductionmentioning

confidence: 99%

Systemic to Pulmonary Arterial Fistula of the Chest Wall and Lung Following Lobectomy

Syme

¹

1975

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SUMMARY The comparatively few cases on record of shunting of blood from systemic arteries of the chest wall to the pulmonary circulation are classified according to their parietal or pulmonary origin and listed chronologically. The clinical features, plain radiological findings, angiographic investigation and possible aetiological mechanisms are reviewed, with particular reference to five of the group which followed a thoracic surgical procedure. The case is presented of a further fistula fed by multiple intercostal arteries and draining to pulmonary artery branches which complicated lobectomy. Particular reference is made to the plain film appearances of a local pulmonary lesion of vascular configuration and definite notching of adjacent ribs, a combination of findings not previously reported in a postoperative fistula. Stress is laid on the complementary roles of aortography, the definitive contrast study in this instance, and of pulmonary angiography in demonstrating the exact site of the shunt and its magnitude on the one hand, and its effect on the lesser circulation on the other. The development of two separate foci of abnormal vascular communication, each at some distance from the level of the original thoracotomv, is noted to be a further hitherto unrecorded finding for a fistula complicating surgical interference.

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“…Congenital arteriovenous fistula (AVF) results from persistence of the embryonic communicating branches between arteries and veins. 8 Acquired AVFs have been reported both in humans and dogs after trauma (eg, penetrating wound or surgery). 9,10 Congenital AVFs have been described previously in the liver of dogs, [11][12][13][14] but rarely in other sites.…”

mentioning

confidence: 99%

Esophageal Varices Due to a Probable Arteriovenous Communication in a Dog

Bertolini¹,

Lorenzi²,

Ledda³

et al. 2007

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A 6-year-old 40-kg castrated male Samoyed dog was presented for evaluation of chronic remittent lameness of the right forelimb. The dog had a history of polyuria-polydipsia (PU/PD) and lethargy over the previous year. Physical examination was unremarkable except for a grade II systolic murmur at the apex of the heart on the left side. A 6-lead ECG was within normal limits. Arterial blood gas analysis indicated mild respiratory alkalosis (pH, 7.457, reference range, 7.370-7.450 Thoracic radiographs disclosed a generalized increase in the size of the cardiac silhouette and pulmonary vascular enlargement, suggesting pulmonary overcirculation. An ELISA for Dirofilaria immitis antigen was negative. Two-dimensional, M-mode echocardiography a (transducer frequency, 2.0-3.0 MHz) revealed left atrial enlargement, left ventricular eccentric hypertrophy, and impaired systolic function (end-diastolic dimension, 65.7 mm; end-systolic dimension, 44.2 mm; shortening fraction, 32.7%) with normal valves. Spectral and colorflow Doppler examination disclosed mild mitral, aortic, and pulmonic valve insufficiency. Both the tricuspid and the telediastolic pulmonic valvular peak regurgitant jet velocities were increased as follows: 3.26 m/s (normal, #2.5 m/s) and 2.44 m/s (normal, #2.0 m/s), respectively. According to the Bernoulli's equation modification, the systolic pulmonary artery pressure was estimated to be 42.5 mm Hg and the diastolic pulmonary artery pressure was estimated to be 23.9 mm Hg, values consistent with mild pulmonary hypertension.The dog was anesthetized and subjected to radiography of the right forelimb and total body multidetector computed tomography b (MDCT). The radiographs were negative for abnormalities, and synovial fluid examination of the shoulder and stifle joints did not indicate evidence of any inflammatory pathology. MDCT scans of the brain, thorax, and abdomen were obtained. For the thoracic and abdominal scans, the dog was positioned in dorsal recumbency, and we employed the following parameters: helical modality, 120 kV, 200 mA, 0.7-second rotation tube, 0.526 pitch, and 1.2-mm slice thickness. For the brain scan, the dog was positioned in sternal recumbency and the scanner parameters were as follows: axial modality, 120 kV, 310 mA, 2-second rotation tube, 0.625 slice thickness, and 10-mm intervals. For an enhanced series, 2-mL/kg iodixanol c 320 mg I/mL was injected via a 22-gauge catheter into the right cephalic vein at a 3 mL/second infusion rate, through a computed tomography injector system. d The brain and abdominal MDCT scans were normal. However, MDCT of the neck and chest revealed 12 pairs of ribs, an enlarged heart, and enlarged pulmonary vessels. Both of the bronchoesophageal arteries were enlarged and connected with an enormous network of homogeneously enhancing serpentine structures involving the thoracic esophagus (esophageal and paraesophageal varices). The bronchoesophageal vein was extremely dilated (Figs 1, 2). The right azygous and hemizygous veins were normal. The cranial vena ca...

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Esophageal Varices due to a Probable Arteriovenous Communication in a Dog

Bertolini

¹

,

Lorenzi

²

,

Ledda

³

et al. 2007

Veterinary Internal Medicne

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A 6-year-old 40-kg castrated male Samoyed dog was presented for evaluation of chronic remittent lameness of the right forelimb. The dog had a history of polyuria-polydipsia (PU/PD) and lethargy over the previous year. Physical examination was unremarkable except for a grade II systolic murmur at the apex of the heart on the left side. A 6-lead ECG was within normal limits. Arterial blood gas analysis indicated mild respiratory alkalosis (pH, 7.457, reference range, 7.370-7.450 Thoracic radiographs disclosed a generalized increase in the size of the cardiac silhouette and pulmonary vascular enlargement, suggesting pulmonary overcirculation. An ELISA for Dirofilaria immitis antigen was negative. Two-dimensional, M-mode echocardiography a (transducer frequency, 2.0-3.0 MHz) revealed left atrial enlargement, left ventricular eccentric hypertrophy, and impaired systolic function (end-diastolic dimension, 65.7 mm; end-systolic dimension, 44.2 mm; shortening fraction, 32.7%) with normal valves. Spectral and colorflow Doppler examination disclosed mild mitral, aortic, and pulmonic valve insufficiency. Both the tricuspid and the telediastolic pulmonic valvular peak regurgitant jet velocities were increased as follows: 3.26 m/s (normal, #2.5 m/s) and 2.44 m/s (normal, #2.0 m/s), respectively. According to the Bernoulli's equation modification, the systolic pulmonary artery pressure was estimated to be 42.5 mm Hg and the diastolic pulmonary artery pressure was estimated to be 23.9 mm Hg, values consistent with mild pulmonary hypertension.The dog was anesthetized and subjected to radiography of the right forelimb and total body multidetector computed tomography b (MDCT). The radiographs were negative for abnormalities, and synovial fluid examination of the shoulder and stifle joints did not indicate evidence of any inflammatory pathology. MDCT scans of the brain, thorax, and abdomen were obtained. For the thoracic and abdominal scans, the dog was positioned in dorsal recumbency, and we employed the following parameters: helical modality, 120 kV, 200 mA, 0.7-second rotation tube, 0.526 pitch, and 1.2-mm slice thickness. For the brain scan, the dog was positioned in sternal recumbency and the scanner parameters were as follows: axial modality, 120 kV, 310 mA, 2-second rotation tube, 0.625 slice thickness, and 10-mm intervals. For an enhanced series, 2-mL/kg iodixanol c 320 mg I/mL was injected via a 22-gauge catheter into the right cephalic vein at a 3 mL/second infusion rate, through a computed tomography injector system. d The brain and abdominal MDCT scans were normal. However, MDCT of the neck and chest revealed 12 pairs of ribs, an enlarged heart, and enlarged pulmonary vessels. Both of the bronchoesophageal arteries were enlarged and connected with an enormous network of homogeneously enhancing serpentine structures involving the thoracic esophagus (esophageal and paraesophageal varices). The bronchoesophageal vein was extremely dilated (Figs 1, 2). The right azygous and hemizygous veins were normal. The cranial vena ca...

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Abnormal Vascular Communications

Cited by 3 publications

References 19 publications

Systemic to Pulmonary Arterial Fistula of the Chest Wall and Lung Following Lobectomy

Systemic to Pulmonary Arterial Fistula of the Chest Wall and Lung Following Lobectomy

Esophageal Varices Due to a Probable Arteriovenous Communication in a Dog

Esophageal Varices due to a Probable Arteriovenous Communication in a Dog

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