Systemic‐pulmonary artery shunt: A rare cause of false‐positive filling defect in the pulmonary arteries

Chawla, Ashish; Bosco, Jerome Irai Ezhil; Lim, Tze Chwan; Gaikwad, Vishal; Chung, Raymond

doi:10.1111/1754-9485.12469

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…There are physiological connections between these two systems at a capillary and pre-capillary level. However, it is extremely rare to detect them radiologically [ 4 , 5 ]. The systemic artery to pulmonary artery shunts are usually diagnosed early in the lifetime when they are due to congenital heart or lung disease.…”

Section: Discussionmentioning

confidence: 99%

“…Systemic artery to pulmonary artery shunt is a rare cause of filling defects in the pulmonary arteries on CTPA [ 7 ]. Other common causes of filling defects include motion artifacts, low contrast enhancement, or streak artifacts [ 4 ]. Pulmonary artery sarcomas have also been reported to mimic pulmonary embolism by showing the proximal filling defect [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Systemic Artery to Pulmonary Artery Shunt Mimicking Acute Pulmonary Embolism, Unmasked by a Multimodality Imaging Approach

Dissaux

Floch²,

Pennec³

et al. 2022

Tomography

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In this report, we describe the functional imaging findings of systemic artery to pulmonary artery shunt in V/Q SPECT CT imaging. A 63-year-old man with small-cell lung cancer underwent CT pulmonary angiography (CTPA) for suspected acute pulmonary embolism (PE). The CTPA showed an isolated segmental filling defect in the right lower lobe, which was initially interpreted as positive for PE but was actually the consequence of a systemic artery to pulmonary artery shunt due to the recruitment of the bronchial arterial network by the adjacent tumor. A V/Q SPECT/CT scan was also performed, demonstrating a matched perfusion/ventilation defect in the right lower lobe.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systemic Artery to Pulmonary Artery Shunt Mimicking Acute Pulmonary Embolism, Unmasked by a Multimodality Imaging Approach

Dissaux

Floch²,

Pennec³

et al. 2022

Tomography

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show abstract

“…In contrast, multidetector row computed tomography (MDCT) is a less invasive screening method for the evaluation of SPSs. The several imaging findings suggestive of SPSs in CT angiography (CTA) are: (1) abnormal enhancement of the responsible pulmonary arterial branches and dilatation of corresponding systemic arterial branches on CT angiography at systemic arterial timing (CTA-S) [ 12 , 13 ]; and (2) abnormal filling defects in the responsible pulmonary arterial branches on CT angiography at pulmonary arterial timing (CTA-P) [ 10 , 14 , 15 ]. The diagnostic performance of the SPSs for CTA-S has been reported to have high sensitivity and specificity [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Serial assessment of computed tomography angiography for pulmonary and systemic arteries using a reduced contrast agent dose for the diagnosis of systemic artery-to-pulmonary artery shunts

Fukamatsu,

Yamada,

Yamada

et al. 2023

Jpn J Radiol

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Purpose To evaluate the diagnostic performance and feasibility of a modified computed tomography (CT) scan protocol, we performed a serial assessment of the computed tomography angiography for pulmonary artery (CTA-P) and systemic artery (CTA-S) (CTA-PS) using a reduced contrast agent dose to diagnose systemic artery-to-pulmonary artery shunts (SPSs). Materials and methods Twenty-five patients who underwent multiphase contrast-enhanced chest CT and conventional chest angiography were included. Three image sets (CTA-P, CTA-S, and CTA-PS) were evaluated by two board-certified radiologists. The visualization of the CT image findings associated with SPSs, such as filling defects and enhancement in the pulmonary arteries, was evaluated using a 5-point scale. Results The diagnostic performance (sensitivity, specificity, and accuracy) of CT imaging findings associated with SPSs in CTA-P and CTA-PS were as follows: CTA-P, 57.1%, 87.5%, and 62.0%; CTA-PS, 81.0%, 100.0%, and 84.0%. CT findings associated with SPSs in CTA-P were significantly sensitive to the CTA-PS protocol. There were no significant differences between the CTA-S and CTA-PS protocols. The area under the curve (AUC) of the CT imaging findings associated with SPSs in the CTA-P and CTA-PS groups was 0.835 and 0.911, respectively (P = 0.191). The AUC of the CT imaging findings associated with SPSs in CTA-S and CTA-PS were 0.891 and 0.926, respectively (P = 0.373). Conclusion CTA-PS using a reduced contrast agent dose protocol could improve the overall diagnostic confidence of SPSs, owing to better visualization of CT imaging findings associated with SPSs compared to individual assessments of CTA-P or CTA-S. Therefore, CTA-PS can be used as an alternative preembolization evaluation modality to conventional angiography in patients with hemoptysis suspected of having SPSs.

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Imaging of Pulmonary Artery

Chawla

2019

Thoracic Imaging

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Systemic‐pulmonary artery shunt: A rare cause of false‐positive filling defect in the pulmonary arteries

Cited by 4 publications

References 10 publications

Systemic Artery to Pulmonary Artery Shunt Mimicking Acute Pulmonary Embolism, Unmasked by a Multimodality Imaging Approach

Systemic Artery to Pulmonary Artery Shunt Mimicking Acute Pulmonary Embolism, Unmasked by a Multimodality Imaging Approach

Serial assessment of computed tomography angiography for pulmonary and systemic arteries using a reduced contrast agent dose for the diagnosis of systemic artery-to-pulmonary artery shunts

Imaging of Pulmonary Artery

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