title: Unusual Pulmonary Arterial Filling Defect caused by Systemic to Pulmonary Shunt in the Setting of Chronic Lung Disease Demonstrated by Dynamic 4D CTA.
abstract: Even though pulmonary embolism is by far the most common cause of filling defect in the pulmonary arterial system, other less common etiologies should be considered especially in the setting of atypical clinical scenario or unusual imaging findings. Unusual pattern of filling defect in the pulmonary artery in the setting of chronic inflammatory/fibrotic parenchymal lung disease should raise the concern for systemic to pulmonary artery shunt. This diagnosis is typically made by conventional angiography. Dynamic 4D CT angiography however can be a safe, noninvasive and effective alternative tool for making such a diagnosis. It has the added value of multiplanar reconstruction capabilities and providing detailed anatomy which can be vital for interventional radiologists when planning their approach for possible intervention. We present 2 cases of such shunts, and illustrate the demonstration of these shunts by using dynamic 4D CT angiography.
authors.affiliation: Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Kianoush
authors.initials: K
authors.lastname: Ansari-Gilani
authors.affiliation: Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gilkeson
authors.affiliation: Department of Radiology, Macquarie University Hospital, Macquarie University, Australia.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Hsiao
authors.affiliation: Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Prabhakar
authors.initials: P
authors.lastname: Rajiah
mesh_terms: D000369:Aged, 80 and over; D000638:Amiodarone / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D000072226:Computed Tomography Angiography; D003287:Contrast Media; D003550:Cystic Fibrosis / Q000150:complications*; D003937:Diagnosis, Differential; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D008297:Male; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000187:drug effects; D013902:Radiography, Thoracic; D016157:Vascular Fistula / Q000000981:diagnostic imaging* / Q000209:etiology*
chemical_list: D000889:Anti-Arrhythmia Agents; D003287:Contrast Media; D000638:Amiodarone
keywords: Shunt; angiography; chronic lung disease; dynamic CT; pulmonary embolism