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Pulmonary Vascular Diseases

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Abstract

This chapter describes pulmonary embolism and infarction, non-thrombotic pulmonary emboli (fat embolism syndrome, amniotic fluid emboli, foreign body emboli, tumor emboli), chronic pulmonary embolism, pulmonary arterial hypertension, and pulmonary veno-occlusive disease.

Keywords

  • Pulmonary embolism
  • Fat embolism syndrome
  • Amniotic fluid emboli
  • Foreign body emboli
  • Tumor emboli
  • Chronic pulmonary embolism, pulmonary arterial hypertension
  • Pulmonary veno-occlusive disease

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Fig. e9.1

Westermark sign Westermark sign of pulmonary embolism. (a) Baseline image demonstrates normal vascularity in the left upper lobe (TIF 917 kb)

Fig. e9.1

Westermark sign Westermark sign of pulmonary embolism. (b) Striking hyperlucency of the left upper lobe coincided with the onset of the patient’s symptoms (TIF 895 kb)

Fig. e9.1

Westermark sign Westermark sign of pulmonary embolism. (c) Arteriogram performed on the same day shows an occluding clot in the left upper lobe and multiple emboli in the right lung [1] (TIF 851 kb)

Fig. e9.2

Acute pulmonary embolism Acute pulmonary embolism. Multiple filling defects in pulmonary arteries bilaterally. (Courtesy of Jennifer Ni Mhuircheartaigh, MD, Boston) (TIF 629 kb)

Fig. e9.3

Acute pulmonary embolism. Soft-tissue filling of the posterobasal segment of the right lower lobe artery (arrow). The artery is enlarged compared with enhancing adjacent patent vessels [3] (TIF 1548 kb)

Fig. e9.4

Acute pulmonary embolism. Filling defect surrounded by contrast material (arrow) in the laterobasal segment of the right lower lobe [3] (TIF 1548 kb)

Fig. e9.5

Acute pulmonary embolism Acute pulmonary embolism. Long, clot-filled pulmonary artery (arrows). (Courtesy of Jennifer Ni Mhuircheartaigh, MD, Boston) (TIF 619 kb)

Fig. e9.6

Pulmonary infarct Pulmonary infarct. (a) Wedge-shaped opacity in the anterior segment of the right upper lobe (arrow) representing an early pulmonary infarct. (Courtesy of Gillian Lieberman, MD, Boston) (TIF 1329 kb)

Fig. e9.6

Pulmonary infarct Pulmonary infarct. (b) Scan using mediastinal window shows multiple filling defects within the contrast-enhanced pulmonary arteries, compatible with pulmonary emboli. These have propagated into segmental and subsegmental pulmonary arteries. (Courtesy of Gillian Lieberman, MD, Boston) (TIF 82 kb)

Fig. e9.7

Radionuclide ventilation-perfusion (V/Q) lung scan Radionuclide ventilation-perfusion (V/Q) lung scan. (a) Normal ventilation scan. (Courtesy of J. Anthony Parker, MD/PhD, Boston) (TIF 997 kb)

Fig. e9.7

Radionuclide ventilation-perfusion (V/Q) lung scan Radionuclide ventilation-perfusion (V/Q) lung scan. (b) Abnormal perfusion scan. On the left lateral view, there is a large defect in the anterior-basilar segment of the left lower lobe (white arrow) and a smaller defect in the superior segment (black arrow). On the RPO view, there is decreased perfusion in the apical segment of the right upper lobe. (Courtesy of J. Anthony Parker, MD/PhD, Boston) (TIF 839 kb)

Fig. e9.8

Amniotic fluid embolism Amniotic fluid embolism. Extensive bilateral perihilar opacities, which developed 6 hours after the onset of acute symptoms [4] (TIF 809 kb)

Fig. e9.9

Talc-induced lung disease Talc-induced lung disease. Fine nodular opacities and areas of coalescence in an intravenous drug abuser [5] (TIF 757 kb)

Fig. e9.10

Talc-induced lung disease. Bilateral irregular nodular areas of high attenuation in the upper lobes [6] (TIF 1399 kb)

Fig. e9.11

Pulmonary artery leiomyosarcoma Pulmonary artery leiomyosarcoma. Homogeneous mass fills the left main pulmonary artery and extends into the left upper and lower lobe pulmonary arteries (arrows) [7] (TIF 1289 kb)

Fig. e9.12

Chronic pulmonary thromboembolism Chronic pulmonary thromboembolism. Extensive collateral bronchial arteries associated with the large embolus in the main and more peripheral pulmonary arteries (arrowhead) [3] (TIF 837 kb)

Fig. e9.13

Pulmonary arterial hypertension Pulmonary arterial hypertension. (a) Features of chronic pulmonary hypertension (right atrial and ventricular enlargement), bulging of the interventricular septum (arrow), and central pulmonary arterial enlargement with peripheral tapering in this patient with scleroderma [8] (TIF 553 kb)

Fig. e9.13

Pulmonary arterial hypertension Pulmonary arterial hypertension. (b) Features of chronic pulmonary hypertension (right atrial and ventricular enlargement), bulging of the interventricular septum (arrow), and central pulmonary arterial enlargement with peripheral tapering in this patient with scleroderma [8] (TIF 614 kb)

Fig. e9.14

Pulmonary artery hypertension Pulmonary artery hypertension. (a) Dilatation (3 cm) of the main pulmonary artery, which is substantially larger than the ascending aorta (arrow) [9]. (TIF 135 kb)

Fig. e9.14

Pulmonary artery hypertension Pulmonary artery hypertension. (b) In another patient with multiple pulmonary emboli, there are sharply defined areas of variable lung attenuation compatible with mosaic perfusion [2] (TIF 114 kb)

Fig. e9.15

Pulmonary veno-occlusive disease Pulmonary veno-occlusive disease. (a) Radiograph demonstrates pulmonary edema in a young adult with acute dyspnea. (TIF 764 kb)

Fig. e9.15

Pulmonary veno-occlusive disease Pulmonary veno-occlusive disease. (b) CT images obtained 2 days after admission demonstrate numerous inter- and intralobular thickened septa, peribronchial cuffing, small pleural effusions, and residual diffuse ground-glass attenuation. The diagnosis was made at lung biopsy [10] (TIF 568 kb)

Fig. e9.15

Pulmonary veno-occlusive disease Pulmonary veno-occlusive disease. (c) CT images obtained 2 days after admission demonstrate numerous inter- and intralobular thickened septa, peribronchial cuffing, small pleural effusions, and residual diffuse ground-glass attenuation. The diagnosis was made at lung biopsy [10] (TIF 570 kb)

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Eisenberg, R.L. (2020). Pulmonary Vascular Diseases. In: What Radiology Residents Need to Know: Chest Radiology . Springer, Cham. https://doi.org/10.1007/978-3-030-16826-1_9

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  • DOI: https://doi.org/10.1007/978-3-030-16826-1_9

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