Imaging Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK.
Vascular Science, National Heart and Lung Institute, ICTEM, Imperial College London, London, UK; VASCERN HHT European Reference Centre and Respiratory Medicine, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK.
Clin Radiol. 2021 Sep;76(9):711.e9-711.e15. doi: 10.1016/j.crad.2021.03.016. Epub 2021 Apr 23.
To describe the causes and computed tomography (CT) and angiographic appearances of transpleural systemic artery-to-pulmonary artery shunts in patients without chronic inflammatory lung disease and determine their best management.
All patients referred to a tertiary referral unit between January 2009 and January 2020 in whom a diagnosis of a systemic-to-pulmonary artery communication without underlying chronic inflammatory lung disease was subsequently made have been included in this report. Medical records and imaging findings were reviewed retrospectively.
Ten patients (male: female ratio = 7:3; median age 42 years [range 22-70 years]) with systemic artery-to-pulmonary artery shunts without chronic inflammatory lung disease were identified. Five were misdiagnosed as having a pulmonary arteriovenous malformation and had been referred for embolisation. In six patients, there was either a history of accidental or iatrogenic thoracic trauma or of inflammatory disease involving the pleura, and in two patients, in whom a previous medical history could not be obtained, there were CT features suggesting previous pleural inflammatory disease. Two shunts were thought to be congenital. All individuals were asymptomatic other than one with localised thoracic discomfort that dated from the time of surgery. All patients were managed conservatively and have remained well with a median follow-up of 4.5 years (range 1-11.3 years).
Localised transpleural systemic artery-to-pulmonary artery shunts in the absence of chronic inflammatory lung disease are usually related to previous thoracic trauma/intervention or abdominal or pulmonary sepsis involving a pleural or diaphragmatic surface. Congenital shunts are rare. The present study and much of the literature supports conservative management.
描述无慢性炎症性肺疾病患者的胸腔内体动脉-肺动脉分流的病因、计算机断层扫描（CT）和血管造影表现，并确定其最佳治疗方法。
本报告纳入了 2009 年 1 月至 2020 年 1 月期间转诊至三级转诊中心的所有患者，这些患者被诊断为无慢性炎症性肺疾病的体动脉-肺动脉交通。回顾性分析了病历和影像学资料。
10 例（男：女=7：3；中位年龄 42 岁[范围 22-70 岁]）患者被诊断为无慢性炎症性肺疾病的体动脉-肺动脉分流。其中 5 例误诊为肺动静脉畸形，曾转诊进行栓塞治疗。6 例患者有胸外伤或医源性胸外伤或胸膜炎症性疾病史，2 例患者无法获得既往病史，CT 特征提示既往胸膜炎症性疾病。2 个分流被认为是先天性的。除 1 例因局部胸痛（发病于手术时）外，所有患者均无症状。所有患者均接受保守治疗，中位随访时间为 4.5 年（范围 1-11.3 年），情况良好。
无慢性炎症性肺疾病的局灶性胸腔内体动脉-肺动脉分流通常与既往胸外伤/干预、累及胸膜或膈肌表面的腹部或肺部脓毒症或先天性分流有关。本研究和大多数文献均支持保守治疗。
