Mindaugas Mataciunas

CT angiography of mildly symptomatic, isolated, unilateral right pulmonary vein atresia

We report a mildly symptomatic 12-year-old boy with a very rare congenital anomaly—isolated unilateral pulmonary vein atresia. Diagnosis was made using CT angiography and its role in diagnosis is discussed.

Meandering pulmonary veins mimicking arteriovenous malformation

We report a case of preoperative incidental finding in a 34-year-old man with a significant aortic insufficiency. Preoperative chest x-ray was suspicious for arteriovenous malformation in the right lung. Chest CT angiography discovered an anomalous course of the left superior pulmonary vein crossing the mediastinum to the contralateral hemithorax, joining the right superior pulmonary vein before entering the right inferior pulmonary vein and forming a common trunk of right inferior pulmonary vein.

Preoperative predictors of conversion in thoracoscopic surgery for pleural empyema

OBJECTIVES Thoracoscopy is an effective treatment method for pleural empyema; however, it is still not well defined as to which patient subgroups could benefit from it the most. The aim of the study was to identify preoperative factors that could facilitate selecting appropriate surgical intervention and to evaluate early postoperative period. METHODS Seventy-one patients were prospectively included in the study, which was conducted from January 2011 to June 2014. Thoracoscopic surgery for Stage II/III pleural empyema was performed in all patients. Thoracoscopy failed in 18 (25.4%) patients, requiring conversion to thoracotomy. The preoperative factors that could possibly predict conversion were analysed. RESULTS Obliterated pleural space (12 patients) and failure to achieve lung re-expansion (6 patients) were the main reasons for conversion. Multivariable logistic regression analysis demonstrated that each day of illness [odds ratio 1.1 (95% confidence interval 1.0-1.2], P  = 0.004] and frank pus [odds ratio 4.4 (95% confidence interval 1.2-15.3), P  = 0.021] were independent predictors of conversion. Using receiver-operating characteristic analysis, it was determined that the duration of illness had a high predictive value for conversion [area under the curve 0.8 (95% confidence interval 0.7-0.9), P  < 0.001]. The cut-off value for duration of illness was 16 days (sensitivity 94.4%, specificity 54.7%). The conversion group had a significantly greater need for postoperative intensive care unit stay ( P  = 0.022) but a lower rate of reoperations ( P  = 0.105). CONCLUSIONS Duration of illness and frank pus discovered during thoracocentesis can help in selecting the patient for appropriate intervention. Earlier surgery for pleural empyema can reduce the rate of conversion and reoperation.

Classic Dissection of Thoracic Aorta Complicated by Ascending Aortic Intramural Hematoma: Promt Diagnosis and Successful Endovascular Repair

We reported a case of 68-year-old man, with a previous history of hypertension. Patient was admitted to our institution for evaluation of a severe, constant, tearing anterior chest pain radiated to the neck with suspicion of acute aortic dissection. A multidetector computed tomography scan of thorax and abdomen demonstrated a dissection starting from the middle part of aortic arch and extending downward to the descending aorta till the middle part of the thoracic aorta. The dissection was classified as Stanford A, De Bakey I. Surgical treatment of patient was started with bypass graft from the right common carotid artery to the left common carotid with subsequent revascularization of left subclavian artery. Lower parts of above-mentioned arteries were ligated. At the second stage an emergent prosthetic stent-graft was placed distally from the truncus brachiocephalicus up to the proximal part of the descending aorta. We reported a case report to present diagnostic and possible interventional treatment for patient with acute aortic type A dissection.

Imaging findings of an asymptomatic child with pulmonary vein atresia: reply to Gasparetto

Sir, Gasparetto et al. [1] present an interesting case report of a rare anomaly—asymptomatic unilateral pulmonary vein atresia that was confirmed by magnetic resonance angiography. Unlike the case reported at our institution [2], the girl had no symptoms and on follow-up after 5 years she remained asymptomatic. An asymptomatic or mildly symptomatic course of this anomaly could be explained by complexity and pliability of the bronchopulmonary circulation. Liebow [3] showed a double venous drainage in normal human lungs consisting of pulmonary and bronchial veins that intercommunicate between each other. Proximal bronchial veins drain into the azygos, hemiazygos and intercostal veins and pulmonary veins drain into the left atrium. Presumably connections between the pulmonary veins and the caval system via azygos veins are capable of expansion or proliferation in various congenital or acquired pathological conditions. Definitive diagnosis and functional parameters of this anomaly require invasive angiography, but because the girl is asymptomatic, postponement of this procedure could be justifiable. We suggest that increasing availability of cross-sectional techniques (CT, MR) with comprehensive three-dimensional visualization will be used more frequently as a first-line modality to clarify incidental findings. Therefore it is possible that this cardiovascular defect will appear to be not so infrequent.