Pulmonary hypertension could have thoracic lymphatic abnormalities caused by right ventricular failure. Since there is no description of such abnormalities, the purpose of this study was to investigate them with magnetic resonance. Prospective review magnetic resonance T2-weighted lymphangiography was performed between January 2017 and October 2019 through quantitative thoracic duct diameter, diameter index and qualitative lymphatic abnomalities types: 1- little or none abnormalities, 2-abnormalities in supraclavicular region, 3-abnormalities extending into the mediastinum, and 4-abnormalities extending into the lung. Five patients group 1 pulmonary arterial hypertension participated in this study. The mean: age was 12.44±4.92 years old, three male and two female, The quantitative analysis yielded the following results: mean thoracic duct diameter of 2.92±0.16 mm, and thoracic duct index 2.28±1.03 mm/m2. Qualitative lymphangiography abnormalities were type 1 in three patients, type 2 in one, all with low risk determinants and type 3 in one with hight risk determinants and rigth ventricular faillure. Magnetic resonance T2-weighted lymphangiography in group 1 paediatric pulmonary arterial hypertension allowed for the identification of the thoracic duct, wich was used to perform both quantitative and qualitative analysis of thoracic lymphatic abnormalities, in particular when increased high risk determinants and rigth ventricular faillure were present, These features represents an extracardiac findings useful to understand systemic venous congestion impact on lymphatic system.
Occurrence of left atrial appendage (LAA) thrombus is a frequent complication of atrial fibrillation (AF) and it increase thromboembolic risk. Transesophageal echocardiography (TEE) is considered the gold standard to ensure that this chamber is thrombus free. Multidetector computed tomography (CT) scan has some advantages such the possibility to get 3D reconstruction and explore another structures in relationship with the LAA. However, lack of specificity in case of false positive images with filling defects due to slow velocities in the LAA. Methods and Results: 34 patiens with suspected thrombus by a previous CT scan or transesophageal echo were included in analisys. The aim of study was evaluated the utility of CT scan with delayed acquisition protocol to exclude LAA thrombus. In all of patients, complete LAA filling was observed, with a sensitivity, specificity and negative predictive value of 100% to differentiate circulatory stasis from thrombus. Conclusion: Perform a CT scan with a delayed acquisition protocol and in prone position are safe techniques to rule out fake thrombus.
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