THORACIC Section 16: Pulmonary arteries and veins

Question 1

What are the 2 major forms of anomalous anatomy of the pulmonary and veins?

Answer 1

Parital (PAPVR) or

Total (TAPVR)

Anomalous pulmonary venous return.

Question 2

PAPVR/TAPVR drain into?

Answer 2

systemic system

Question 3

Where should the pulmonary veins drain?

Answer 3

Left atrium

Question 4

Defined as one (or more) of the four pulmonary veins draining into the right atrium (or SVC)

Answer 4

Partial anomalous venous return

Question 5

What consitions does PAPVR associated?

Answer 5

ASD

Question 6

Most classic type of ASD PAPVR is associated

Answer 6

Sinus venosus type

Question 7

Schmitiar syndrome is PAPVR + ?

Answer 7

PAPVR + Pulmonary hypoplasia

Question 8

The most common pattern of PAPVR

Answer 8

Right superior pulmonary vein draining in to the SVC (Junction of SVC and RA)

Question 9

Less common PAPVR

Answer 9

Left sided

Question 10

What is the “classic” look of PAPVR

Answer 10

“Vertical Vein” draining a left pulmonary vein into the left brachiocephalic vein

Question 11

The dilated right inferior pulmonary vein (PAPVR) draining into the IVC

Answer 11

Schimitar Sign

Question 12

Sword VEin + Tiny Lung

Answer 12

Scimitar Syndrome

Question 13

A cyanotic heart disease characterized by all of the pulmonary venous system draining to the right side of the heart.

Answer 13

Total anomalous pulmonary venous return (TAPVR)

Question 14

This is the lost Dad vein, refusing to ask for directions because that is admitting failure.

It takes the scenic route, but it does always return to what structure?

Answer 14

Meandering Pulmonary vein

Left atrium

Question 15

Vein NOT draining into the left atrium causing left-righ shunting

Answer 15

PAPVR/Sciimitar vein

Question 16

Vein draining into the left atrium. NO left-right shunting

Answer 16

Meandering Pulmonary Vein

Question 17

Diagnosis?

Answer 17

Meandering pulmonary vein

Question 18

What causes dilatation of the right pulmonary vein?

Answer 18

Mitral regurgitation

Question 19

Mitral regurgitation causes asymmetric pulmonary edema involving what lobe?

Answer 19

Rightupper lobe.

“Lower vein grows, upper lung shoes (turns white from pulmonary edema)”

“Grower not a shower” - Inferior pulmonary vein

Question 20

Congenital absence of the right (or left) pulmonary artery with the more distal vasculature present.

Answer 20

Proximal Interruption of the Pulmonary Artery

Question 21

The distal pulmonary arterial tree is supplied by?

Answer 21

collaterall vessls

Question 22

Diagnosis.

Desrcibe.

Answer 22

Proximal interruption of the Pulmonary Artery

CXR/CT: Volume loss of one hemithorax.

CT + C+: Onley one PA. Raise suspision if with volume loss

Question 23

The side of the Proximal Interruption ofhte Pulmonary Artery is determined by the side of what structure?

Answer 23

Aortic arch.

Absent right PA with left-sided aortic arch
Absent left PA with right-sided aortic arch

Question 24

Priximal Interruption of the Pulmonary Artery is associated with what congenital heart anomaly?

Answer 24

PDA

Question 25

Interrupted LEFT PA is associated with what heart anomaly?

Answer 25

TOF Truncus arteriosus.

Question 26

Persons with Interruption of the Pulmonary Artery has reccurent infections due to?

Answer 26

LACK of arterial blood supply.

Question 27

Gold standard for diagnosis of Pulmonary Embolism?

Answer 27

Catheter Angiography.

Question 28

Diagnosis? What sign?

Answer 28

Pulmonary Embolism Westermark Sign - Regional Oligemia (Reduction of blood flow)

Question 29

Diagnosis? Sign?

Answer 29

Pulmonary Emblolism Fleishner Sign (Enlarged pulmonary artery)

Question 30

Diagnosis? Sign?

Answer 30

Pulmonary Embolism Hampton's Hump (Peripheral Wedge-shaped opacity)

Question 31

Acute vs Chronic PE Central clot

Answer 31

Acute PE

Question 32

Acute vs Chronic PE Peripheral clot

Answer 32

Chronic PE

Question 33

Acute vs Chronic PE VEnous Dilatation

Answer 33

Acute PE

Question 34

Acute vs Chronic PE Shrunken veins with collateral vessels

Answer 34

Chronic PE

Question 35

Acute vs Chronic PE Perivenous Soft tissue edema

Answer 35

Acute PE

Question 36

Acute vs Chronic PE Calcifications within the thrombi and within the venous walls

Answer 36

Chronic PE

Question 37

Acute vs Chronic PE Mosaic attenuation

Answer 37

Chronic PE

Question 38

Acute vs Chronic PE Sudden death from arrythmia or acute right heart failure

Answer 38

Acute PE

Question 39

Acute vs Chronic PE A well descrined cause of pulmonary hypertension

Answer 39

Chronic PE

Question 40

Exam of choice of Acute PE

Answer 40

CT Pulmonary Angiogram

Question 41

Exam of choic of Chronic PE

Answer 41

VQ Scan (Ventilation perfusion scan)

Question 42

Uncommon variant of primary pulmonary hypertension, that affects the post capillary pulmonary vasculature.

Answer 42

Pulmonary Veno-occlusive diease

Question 43

PAH+Normal Wedge

Answer 43

Pulmonary Veno-occlusive disease The normal wedge pressure differentiates it from other post capillary causes

Question 44

PAH+Abnormal Wedge

Answer 44

Left atrial mexoma Mitral Stenosis Pulmonary Vein stenosis

Question 45

Most common cause of Pulmonary Artery Aneurysm/Pseudoaneurysm

Answer 45

Iatrogenic from swan Ganz Catheter (Think about "patients in the ICUS")

Question 46

Other causes of Pulmonary artery aneurysm/Pseudoaneurysm

Answer 46

Behcets (Think about Turkish descent, Mouth and Genital Ulcers) Chronic Pulmonary Embolism

Question 47

This is a zebra cause of pulmonary artery aneurysm that is similar (and maybe the same thing) as Behcets. It is characterized by recurrent thrombophlebitis and pulmonary artery aneurysm formation and rupture.

Answer 47

Hugh-Stovin Syndrome

Question 48

This has a cool name, which instantly makes it high yield for testing. This is a pulmonary artery pseudoaneurysm secondary to pulmonary TB. It usually involves the upper lobes in the setting o f reactivation TB.

Answer 48

Rassmussen Aneurysm

Question 49

Aneurysm from Right ventricular outflow tract (ROVT) repair

Answer 49

TOF Repair complication

Question 50

Pulmonary arterial pressure of Pulmonary Hypertension

Answer 50

>25

Question 51

Most common cause of pulmonary hypertension

Answer 51

Secondary Pulmonary Hypertension

Question 52

Give Causes of Secondary Pulmonary Hypertension

Answer 52

Chronic PE RHF/Strin Lung Parenchymal Problems (Emphysema, Fibrosis)

Question 53

Pulmonary Hypertension + What condition? have an increased mortality.

Answer 53

COPD with high A/PA ratio - PA bigger than the aorta.

Question 54

Normal Pulmary artery Size

Answer 54

<29 mm

Question 55

Diagnosis? Give the Sign

Answer 55

Pulmonary Hypertension Banan and egg sign

Question 56

Diagnosis? Give the Sign

Answer 56

Pulmonary Hypertension Carina Crossover