2000 Hastada Konjenital Mediastinial Vasküler Anomoli Tiplerinin ve Sıklığının Değerlendirilmesi.

Yıl 2022, Cilt: 6 Sayı: 1, 15 - 20, 27.03.2022

Yeliz Dadalı Sercan Özkaçmaz Mustafa Demir İlke Bursalı

https://doi.org/10.30565/medalanya.939714

Öz

Amaç: Toraksın konjenital vasküler anomalileri çok sık olmayıp sıklıkla asemptomatiktirler ve görüntülemelerde tesadüfen saptanırlar. Bu çalışmamızda bölgemizde konjenital mediastinal vasküler anomalilerin sıklığını araştırmayı planladık.

Yöntem: Yaklaşık 2 yıllık bir süreçte non-spesifik semptomlar ile kontrastlı toraks Bilgisayarlı Tomografi (BT) çekilen hastaların özellikleri hastane veri tabanından retrospektif olarak tarandı. Yaş ve cinsiyet gibi demografik özellikler kaydedildi. Tüm Bilgisayarlı Tomografi (BT) BT görüntüleri, persistan sol superior vena kava, azygos lobu, aberran sağ subklavien arter, dilate sol superior interkostal ven, sağ taraflı arkus aorta, situs inversus ve parsiyel anormal pulmoner venöz dönüş anomalileri açısından yorumlandı. Çalışmamızda bulunan insidans değerleri ile önceki çalışmaların sonuçları karşılaştırıldı.

Bulgular: Nihai olarak ortalama yaşı 56.13±14.62 (12-93 yıl) olan 2000 hasta çalışmaya dahil edildi. Bunların 776 (%38.8) tanesi kadın (ortalama yaş 56.93±15.19 (13-93 yıl)) ve 1224 (% 61.2) tanesi erkekti (ortalama yaş 55.63±14.23 (12-88 yıl)). Mediastinal vasküler anomali 62 (%3.1) hastada saptandı. Kadın hastaların 27 (%3.5)’inde ve erkek hastaların 35 (%2.6) ’inde bir mediastinal vasküler anomali gözlemlendi. Çalışmamızdaki en sık saptanan mediastinal vasküler anomali, sağ aberran subklavien arter (n:17, %0.9) ve en nadir görüleni ise parsiyel anormal pulmoner venöz dönüş anomalisi idi (n:1, %0.1). Persistan sol superior vena kava insidansı %0.3 (n:6), azygos lobu %0.7 (n:14), sağ taraflı arkus aorta %0.3 (n:5), situs inversus totalis %0.2 (n:3) ve genişlemiş sol superior interkostal ven ise %0.8 (n:16) olarak bulundu.

Sonuç: Mediastinal vasküler anomaliler nadir olup sıklıkla asemptomatiktir. Ancak bu durumların görüntüleme bulgularının iyi bilinmesi, girişimsel işlemleri doğu biçimde planlamada ve aynı zamanda iatrojenik yaralanmaları önlemede gereklidir.

Anahtar Kelimeler

Bilgisayarlı Tomografi, Bilgisayarlı Tomografi, Parsiyel anormal pulmoner venöz dönüş anomalisi, Sağ aberran subklavien arter, Situs inversus totalis, Genişlemiş sol superior interkostal ven

Evaluation of Congenital Mediastinal Vascular Anomaly Types And Frequencies Among 2000 Cases

Öz

Aim: Congenital vascular malformations of the thorax are not very common. These conditions are mostly asymptomatic and detected incidentally on imaging performed for various complaints. In this study, it is aimed to examine the incidence of congenital thoracic vascular anomalies in our region.

Methods: The features of the patients with non-specific complaints who underwent a thorax Computed Tomography (CT) for over 2 years period were retrospectively reviewed on the hospital database and demographical data (Gender and age) were recorded. All the Computed Tomography CT images were interpreted regarding thoracic vascular anomalies including persistent left superior vena cava, azygos lobe, aberrant right subclavian artery, dilated left superior intercostal vein, right-sided aortic arch, situs inversus, and partial anomalous pulmonary venous return. The incidences of these thoracic vascular anomalies were calculated and compared with previous studies.

Results: A total of 2000 patients with a mean age of 56.13±14.62 (12-93 years) were included in this study. Among them 776 (38.8%) ones were female (mean age 56.93±15.19 (13-93 years)) and 1224 (61.2%) were male (mean age 55.63±14.23 (12-88 years)). Mediastinal vascular anomaly was detected in 62 (3.1%) patients. A mediastinal vascular anomaly was observed in 27 (3.5%) female patients and 35 (2.6%) male patients. The most common mediastinal vascular anomaly inthis study was the right aberrant subclavian artery (n:17, 0.9%) and the rarest was partial anomalous pulmonary venous return (n:1, 0.1%). Persistent left superior vena cava incidence was 0.3% (n:6), azygos lobe 0.7% (n:14), right-sided aortic arch 0.3% (n:5), situs inversus totalis 0.2% (n:3), and dilated left superior intercostal vein 0.8% (n:16).

Conclusion: Mediastinal vascular anomalies are rare and usually asymptomatic. But the imaging findings of these conditions must be well-known to accurately planning the interventions and also to prevent iatrogenic injuries.

Anahtar Kelimeler

Computed Tomography, Computed Tomography, Partial anomalous pulmonary venous return, Aberrant right subclavian artery, Situs inversus totalis, Dilated left superior intercostal vein

Kaynakça

• 1. Haramati LB, Flickstein JS, Issenberg HJ, Haramati N, Crooke GA. MR imaging and CT of vascular anomalies and connections in patients with congenital heart disease: significance in surgical planning. RadioGraphics. 2002;22(2):337–47 doi: 10.1148/radiographics.22.2.g02mr09337.
• 2. Povoski SP, Khabiri H. Persistent left superior vena cava: Review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients. World J Surg Oncol. 2011;9:173 doi: 10.1186/1477-7819-9-173.
• 3. Pretorius PM, Gleeson FV. Case 74: right-sided superior vena cava draining into left atrium in a patient with persistent left-sided superior vena cava. Radiology. 2004;232(3):730-4. doi: 10.1148/radiol.2323021092.
• 4. Sarodia BD, Stoller JK: Persistent left superior vena cava: case report and literature review. Respir Care. 2000,45(4):411-6. PMID: 10780037.
• 5. Dearstine M, Taylor W, Kerut EK. Persistent left superior vena cava: chest X-ray and echocardiographic findings. Echocardiography. 2000;17(5):453–5 doi: 10.1111/j.1540-8175.2000.tb01164.x.
• 6. Tak T, Crouch E, Drake GB. Persistent left superior vena cava: incidence, significance and clinical correlates. Int J Cardiol. 2002;82(1):91–3 doi: 10.1016/s0167-5273(01)00586-1.
• 7. Pahwa R, Kumar A. Persistent left superior vena cava: an intensivist's experience and review of the literature. South Med J. 2003;96(5):528-9. doi: 10.1097/01.SMJ.0000060885.27846.91.
• 8. Aziz A, Ashizawa K, Nagaoki K, Hayashi K. High resolution CT anatomy of the pulmonary fissures. J Thorac Imaging. 2004;19(3):186-91. doi: 10.1097/01.rti.0000131590.74658.24.
• 9. Kauffman P, Wolosker N, de Campos JR, Yazbek G, Jatene FB. Azygos lobe: a difficulty in video-assisted thoracic sympathectomy. Ann Thorac Surg. 2010;89(6):e57-9. doi: 10.1016/j.athoracsur.2010.03.030.
• 10. Gürün E, Akdulum İ. A Rare Anatomical Variation Detected Incidentally on Computed Tomography of the Thorax: Azygos Lobe. Acta Med Alanya. 2021;5(1):93-7. doi: 10.30565/medalanya.847756.
• 11. Tran CT, Miao KH, Lui F. Anatomy, Thorax, Lung Azygos Lobe. 2020 Aug 10. In:StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.PMID: 30085519.
• 12. Türkvatan A, Büyükbayraktar FG, Olçer T, Cumhur T. Congenital anomalies of the aortic arch: evaluation with the use of multidetector computed tomography. Korean J Radiol. 2009;10(2):176-84. doi: 10.3348/kjr.2009.10.2.176.
• 13. Rosen RD, Bordoni B. Embryology, Aortic Arch. 2021 Feb 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 31985966.
• 14. Chen X, Qu YJ, Peng ZY, Lu JG, Ma XJ. Diagnosis of congenital aortic arch anomalies in Chinese children by multi-detector computed tomography angiography. J Huazhong Univ Sci Technol: Med Sci. 2013;33:447–51. doi: 10.1007/s11596-013-1140-9.
• 15. Davies M, Guest PJ. Developmental abnormalities of the great vessels of the thorax and their embryological basis. Br J Radiol. 2003;76:491–502. doi: 10.1259/bjr/14043447.
• 16. Haesemeyer SW, Gavant ML. Imaging of acute traumatic aortic tear in patients with an aberrant right subclavian artery. AJR Am J Roentgenol. 1999;172:117–20. doi: 10.2214/ajr.172.1.9888750.
• 17. Polguj M, Chrzanowski Ł, Kasprzak JD, Stefańczyk L, Topol M, Majos A. The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations – a systematic study of 141 reports. ScientificWorldJournal. 2014;2014:292734. doi: 10.1155/2014/292734.
• 18. Landeras LA, Chung JH. Congenital Thoracic Aortic Disease. Radiol Clin North Am. 2019;57(1):113-25. doi: 10.1016/j.rcl.2018.08.008.
• 19. Kimura-Hayama ET, Mele´ndez G, Mendiza´bal AL, Meave-Gonza´lez A, Zambrana GF, Corona-Villalobos CP: Uncommon congenital and acquired aortic diseases: role of multidetector CT angiography. Radiographics. 2010;30(1):79–98. doi:10.1148/rg.301095061
• 20. Ho LM, Bhalla S, Bierhals A, Gutierrez F. MDCT of partial anomalous pulmonary venous return (PAPVR) in adults. J Thoracic Imaging. 2009;24(2):89-95. doi: 10.1097/RTI.0b013e318194c942.
• 21. Vyas HV, Greenberg SB, Krishnamurthy R. MR imaging and CT evaluation of congenital pulmonary vein abnormalities in neonates anf ınfants. Radiographics. 2012;32(1):87-98. doi: 10.1148/rg.321105764
• 22. Sogomonian R, Alkhawam H, Zaiem F, Vyas N, Jolly J, Nguyen J, et al. Isolated supra-cardiac partial anomalous pulmonary venous connection causing right heart failure. J Community Hosp Intern Med Perspect. 2016;6(2):30817. doi: 10.3402/jchimp.v6.30817.
• 23. El-Kersh K, Homsy E, Daniels CJ, Smith JS. Partial anomalous pulmonary venous return: A case series with management approach. Respir Med Case Rep. 2019;27:100833. doi: 10.1016/j.rmcr.2019.100833.
• 24. Jonathan R. Dillman, Sai G. Yarram, Ramiro J. Hernandez. Imaging of Pulmonary Venous Developmental Anomalies. AJR Am J Roentgenol. 2009;192(5):1272–85. doi: 10.2214/AJR.08.1526.
• 25. Fumaki B. Central venous Access: a primer for the diagnostic radiology. AJR Am J Roentgenol. 2002;179(2):309-18. doi: 10.2214/ajr.179.2.1790309.
• 26. Spoon JM. Situs inversus totalis. Neonatal Netw. 2001;20(1):59-63. doi: 10.1891/0730-0832.20.1.63.
• 27. Padovan RS, Paar MH, Aurer I. (Mis)placed central venous catheter in the left superior intercostal vein. Radiol Oncol. 2011;45(1):27-30. doi: 10.2478/v10019-010-0043-7.
• 28. Ball JB Jr, Proto AV. The variable appearance of the left superior intercostal vein. Radiology. 1982;144(3):445-52. doi: 10.1148/radiology.144.3.7100455.