Dynamic contrast-enhanced magnetic resonance lymphangiography

Ramirez‐Suarez, Karen I.; Tierradentro-García, Luis Octavio; Smith, Christopher L.; Krishnamurthy, G.; Escobar, Fernando; Otero, Hansel J.; Rapp, Jordan B.; Dori, Yoav; Biko, David M.

doi:10.1007/s00247-021-05051-6

Cited by 27 publications

(13 citation statements)

References 31 publications

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“…T2-weighted imaging has become increasingly important for single-ventricle patients and represents a ‘game changer’ to screen patients with Fontan failure, including PLE and plastic bronchitis. However, new modalities have been described to illustrate the lymphatic perfusion, including nodal, hepatic and mesenteric dynamic contrast lymphangiography (DCMRL) [ 11 , 16 , 18 ]. DCMRL allows for a full characterization of lymphatic perfusion, including physiology, anatomy, and flow of the lymphatic system.…”

Section: Discussionmentioning

confidence: 99%

Serial T2-Weighted Thoracic and Abdominal Lymphatic Imaging in Fontan Patients—New Insights into Dynamics of Lymphatic Abnormalities after Total Cavopulmonary Connection

Moosmann

Schroeder

Rompel

et al. 2022

JCDD

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Lymphatic congestion in single-ventricle patients has been associated with increased morbidity and poor outcomes. Little is known about the dynamics of lymphatic abnormalities over time, on their association with clinical presentation or response to catheter interventions. This retrospective, single-center study describes Fontan patients who underwent at least two magnetic resonance imaging (MRI) studies. T2-weighted lymphatic imaging was used to classify thoracic and abdominal (para-aortic and portal-venous) lymphatic abnormalities. The relationship between lymphatic congestion and hemodynamic changes after cardiac catheter interventions, clinical presentation and MRI data was analyzed. A total of 33 Fontan patients underwent at least two cardiac MRI studies. Twenty-two patients had two, eight had three and three had four lymphatic imaging studies (total of 80 MRIs studies). No significant changes in lymphatic classification between MRI 1 and 2 were observed for thoracic (p = 0.400), para-aortic (0.670) and portal-venous (p = 0.822) abnormalities. No significant correlation between lymphatic classification and hemodynamic changes after intervention or MRI parameters was found. This study illustrates thoracic and abdominal lymphatic abnormalities in serial T2-weighted imaging after Fontan. Fontan patients did not demonstrate significant changes in their lymphatic perfusion, despite clinical or hemodynamic changes. We assume that lymphatic congestion might develop after total cavopulmonary connection (TCPC) and remain relatively stable, despite further intervention targeting hemodynamic parameters.

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Section: Discussionmentioning

confidence: 99%

Serial T2-Weighted Thoracic and Abdominal Lymphatic Imaging in Fontan Patients—New Insights into Dynamics of Lymphatic Abnormalities after Total Cavopulmonary Connection

Moosmann

Schroeder

Rompel

et al. 2022

JCDD

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“…One of the reasons why the children with CHD tended to be younger might be an excessive leakage and retention of lymph in the bronchi related to preexisting lymphatic abnormalities [ 24 , 25 ] exacerbating the circulatory complications after cardiosurgical intervention [ 3 , 4 ]. The increased diameter in lymphatic vessels at lung biopsies [ 6 ] as well as in the images of dynamic contrast-enhanced magnetic resonance lymphangiography [ 26 ] seem to indicate that lymphatic disorders may be involved in the pathogenesis of PB.…”

Section: Discussionmentioning

confidence: 99%

“…The complex of these disorders leads to an improper lymphatic flow through the lymphatic vessels of a respiratory system. Imaging studies such as lymphoscintigraphy, dynamic contrast MR lymphangiography (DCMRL), or conventional lymphangiography have confirmed the relationship between lymphatic disorders and PB in patients after Fontan procedure [ 25 , 26 , 34 ]. One of the treatments of PB include percutaneous lymphatic interventions such as embolization of the thoracic duct [ 6 , 34 ], a surgical intervention for reducing the central venous pressure, and pharmacological management.…”

Section: Discussionmentioning

confidence: 99%

Plastic Bronchitis—A Serious Rare Complication Affecting Children Only after Fontan Procedure?

Pałyga-Bysiecka

Polewczyk

Kołodziej

et al. 2021

JCM

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Background: Plastic bronchitis (PB) may occur not only in children following palliative Fontan procedure but also in those without underlying heart disease. We aim to assess the clinical course, therapeutic measures, outcome, and follow-up of PB in children with congenital heart disease (CHD) and children without cardiac problems. Methods: This retrospective case series assessed children with PB admitted to hospital between 2015 and 2019. Parents or guardians of patients were contacted by e-mail or telephone between September 2017 and June 2019 to enquiry about recurrence of PB and strategy of treatment. The diagnosis of PB was based on the expectoration (spontaneous or during bronchoscopy) of endobronchial plugs. Results: This study delineated the clinical, histological, and laboratory features of plastic bronchitis in children following Fontan procedure (Group A) and in those without heart defects (Group B, non-CHD children). The main symptoms were cough accompanied by dyspnea, and hypoxemia with a decrease in oxygen saturation, often leading to acute respiratory failure. In children with CHD, the first episode of PB occurred at a relatively young age. Although chronic, i.e., lasting more than 3 weeks, inhaled therapy was implemented in both groups of patients, the recurrences of PB were observed. The mean time to PB recurrence after the first episode in Group A was longer than that in Group B (1.47 vs. 0.265 years, p = 0.2035). There was no re-episode with recurrence of PB in 3 cases out of 10 in total in Group A (30%) and 1 case out of 4 in total in Group B (25%). While the majority of children in Group A usually developed bronchial casts on the right side, the patients in Group B (without CHD) suffered from bronchial casts located only on the left side. Conclusions: Despite many similarities, clinical, histological, and laboratory studies in the children with plastic bronchitis after Fontan’s surgery and in children without heart defects suggest that there are differences in the course of the disease in patients without CHD, such as a more advanced age of the first episode of PB, the location of plastic casts on the left side, and a stronger role of inflammatory factors and mechanisms. Further research is needed to understand the pathophysiology of PB and choose the most appropriate therapy.

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“…Tuy nhiên, quan sát kết quả của nút tắc ống ngực hoặc phẫu thuật thắt ống ngực đối với DCPMTP thì một số bệnh nhân thấy không những dịch không giảm đi mà tràn dịch tăng lên rất nhiều sau khi điều trị. Hiện nay, kết hợp các nghiên cứu chẩn đoán không xâm lấn, ví dụ như chụp cộng hưởng từ bạch mạch và hiểu biết hơn về các biến thể giải phẫu của ống ngực thì một phương pháp có hệ thống hơn để tiếp cận chẩn đoán một bệnh nhân từ đó có chiến lược điều trị phù hợp [2]. Trong bài viết này, chúng tôi tập trung nhấn mạnh vai trò của chụp cộng hưởng từ bạch mạch để chẩn đoán các căn nguyên của DCMPTP và cập nhật mới nhất về tiếp cận điều trị những bệnh nhân này.…”

Section: đặT Vấn đềunclassified

Chẩn Đoán Và Điều Trị Tràn Dịch Dưỡng Chấp Màng Phổi Không Do Chấn Thương

Nguyen¹,

Lê²,

Đoàn³

2022

vjrnm

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Tràn dưỡng chấp màng phổi là tình trạng xuất hiện dịch dưỡng chấp trong khoang màng phổi. Có hai bệnh cảnh của tràn dưỡng chấp màng phổi là gặp phải sau phẫu thuật, chấn thương và tràn dưỡng chấp màng phổi tự phát. Nếu trường hợp tràn dưỡng chấp màng phổi sau phẫu thuật/chấn thương chẩn đoán xác định và điều trị can thiệp hiện nay tỷ lệ khỏi rất cao bởi hình thái tổn thương thường là rách ống ngực hoặc nhánh bên của ống ngực thì tràn dưỡng chấp màng phổi tự phát lại rất khó xác định vị trí tổn thương và điều trị là hết sức khó khăn. Những hiểu biết về giải phẫu của tuần hoàn dưỡng chấp hiện nay cho phép chẩn đoán và điều trị thành công ở một số bệnh nhân nhưng tỷ lệ này vẫn còn hạn chế. Bài viết này tổng quan về các nguyên nhân gây tràn dưỡng chấp màng phổi và chiến lược tiếp cận chẩn đoán, điều trị một bệnh nhân rò dưỡng chấp màng phổi tự phát từ can thiệp đến phẫu thuật hoặc gây dính màng phổi.

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Dynamic contrast-enhanced magnetic resonance lymphangiography

Cited by 27 publications

References 31 publications

Serial T2-Weighted Thoracic and Abdominal Lymphatic Imaging in Fontan Patients—New Insights into Dynamics of Lymphatic Abnormalities after Total Cavopulmonary Connection

Serial T2-Weighted Thoracic and Abdominal Lymphatic Imaging in Fontan Patients—New Insights into Dynamics of Lymphatic Abnormalities after Total Cavopulmonary Connection

Plastic Bronchitis—A Serious Rare Complication Affecting Children Only after Fontan Procedure?

Chẩn Đoán Và Điều Trị Tràn Dịch Dưỡng Chấp Màng Phổi Không Do Chấn Thương

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