Extravascular MDCT Findings of Pulmonary Vein Stenosis in Children with Cardiac Septal Defect

Lee, Edward Y.; Callahan, Ryan; Vargas, Sara O.; Jenkins, Kathy J.; Park, Halley J; Gauthier, Zachary; Winant, Abbey J.

doi:10.3390/children8080667

Cited by 3 publications

(10 citation statements)

References 26 publications

(54 reference statements)

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“…The findings of our study correlate well with the findings from previously published studies in pediatric patients with primary and secondary PVS focusing on extrathoracic MDCT findings [16][17][18]. These studies also identified the presence of three main extravascular pleuropulmonary abnormalities on thoracic MDCT in pediatric patients with PVS: GGO, septal thickening, and pleural thickening.…”

Section: Discussionsupporting

confidence: 90%

“…Presented clinical signs and symptoms in these 49 pediatric patients included: failure to thrive (n = 8; 16.3%), pulmonary hypertension (n = 7; 14.3%), shortness of breath (n = 5; 10.2%), hypoxemia (n = 5; 10.2%), fever (n = 3; 6.1%), and bradycardia (n = 2; 4.1%). Extrapulmonary MDCT findings for a subset of these patients were previously reported [16][17][18].…”

Section: Patient Population Characterizationmentioning

confidence: 76%

“…Prematurity was defined as born alive before 37 weeks of pregnancy [22]. The PVS diagnostic criterion was pulmonary vein luminal narrowing in ≥2 vessels with a mean gradient ≥ 4 mm Hg seen on echocardiography or conventional angiography [16][17][18] 5) a 256-MDCT scanner (n = 2; 4%); and (6) a 302-MDCT scanner (n = 1; 5%).…”

Section: Prematurity and Pulmonary Vein Stenosis Diagnostic Criteriamentioning

confidence: 99%

“…Recently, there has been an important paradigm shift in the imaging evaluation of pediatric PVS, change from solely focusing on the identification of affected pulmonary veins to also visualizing the characteristic extravascular thoracic findings of PVS in pediatric patients [16][17][18]. Identification of the characteristic extravascular thoracic findings of PVS in children is important because it can both confirm the diagnosis of PVS (when a narrowed pulmonary vein is visualized or suspected), and it can also suggest the diagnosis of PVS on MDCT studies that were not technically optimized for evaluation of the pulmonary veins.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, this new focus on "seeing the bigger picture" of PVS has improved our understanding of the pathophysiology of this elusive disease. In children with PVS, thoracic MDCT often visualizes a soft tissue proliferation along the pulmonary veins (likely corresponding to the myofibroblast-like proliferation) as well as interlobular septal thickening and alveolar ground-glass opacity (GGO) attributed to decreased pulmonary venous drainage (due to narrowed pulmonary veins) [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Pleuropulmonary MDCT Findings: Comparison between Children with Pulmonary Vein Stenosis and Prematurity-Related Lung Disease

et al. 2022

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Purpose: To retrospectively compare the pleuropulmonary MDCT findings in children with pulmonary vein stenosis (PVS) and prematurity-related lung disease (PLD). Materials and Methods: All consecutive infants and young children (≤18 years old) who underwent thoracic MDCT studies from July 2004 to November 2021 were categorized into two groups—children with PVS (Group 1) and children with PLD without PVS (Group 2). Two pediatric radiologists independently evaluated thoracic MDCT studies for the presence of pleuropulmonary abnormalities as follows—(1) in the lung (ground-glass opacity (GGO), triangular/linear plaque-like opacity (TLO), consolidation, nodule, mass, cyst(s), interlobular septal thickening, and fibrosis); (2) in the airway (bronchial wall thickening and bronchiectasis); and (3) in the pleura (thickening, effusion, and pneumothorax). Interobserver agreement between the two reviewers was evaluated with the Kappa statistic. Results: There were a total of 103 pediatric patients (60 males (58.3%) and 43 females (41.7%); mean age, 1.7 years; range, 2 days–7 years). Among these 103 patients, 49 patients (47.6%) comprised Group 1 and the remaining 54 patients (52.4%) comprised Group 2. In Group 1, the observed pleuropulmonary MDCT abnormalities were—pleural thickening (44/49; 90%), GGO (39/49; 80%), septal thickening (39/49; 80%), consolidation (4/49; 8%), and pleural effusion (1/49; 2%). The pleuropulmonary MDCT abnormalities seen in Group 2 were—GGO (45/54; 83%), TLO (43/54; 80%), bronchial wall thickening (33/54; 61%), bronchiectasis (30/54; 56%), cyst(s) (5/54; 9%), pleural thickening (2/54; 4%), and pleural effusion (2/54; 4%). Septal thickening and pleural thickening were significantly more common in pediatric patients with PVS (Group 1) (p < 0.001). TLO, bronchial wall thickening, and bronchiectasis were significantly more frequent in pediatric patients with PLD without PVS (Group 2) (p < 0.001). There was high interobserver kappa agreement between the two independent reviewers for detecting pleuropulmonary abnormalities on thoracic MDCT angiography studies (k = 0.99). Conclusion: Pleuropulmonary abnormalities seen on thoracic MDCT can be helpful for distinguishing PVS from PLD in children. Specifically, the presence of septal thickening and pleural thickening raises the possibility of PVS, whereas the presence of TLO, bronchial wall thickening and bronchiectasis suggests PLD in the pediatric population.

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Section: Discussionsupporting

confidence: 90%

Section: Patient Population Characterizationmentioning

confidence: 76%

Section: Prematurity and Pulmonary Vein Stenosis Diagnostic Criteriamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pleuropulmonary MDCT Findings: Comparison between Children with Pulmonary Vein Stenosis and Prematurity-Related Lung Disease

et al. 2022

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Computed tomographic parenchymal lung findings in premature infants with pulmonary vein stenosis

et al. 2023

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Lung and Pleural Findings of Children with Pulmonary Vein Stenosis with and without Aspiration: MDCT Evaluation

et al. 2022

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Purpose: To retrospectively compare the lung and pleural findings in children with pulmonary vein stenosis (PVS) with and without aspiration on multidetector computed tomography (MDCT). Materials and Methods: All consecutive children (≤18 years old) with PVS who underwent thoracic MDCT studies from August 2004 to December 2021 were categorized into two groups: children with PVS with aspiration (Group 1) and children with PVS without aspiration (Group 2). Two independent pediatric radiologists retrospectively evaluated thoracic MDCT studies for the presence of lung and pleural abnormalities as follows: (1) in the lung (ground-glass opacity (GGO), consolidation, nodule, mass, cyst(s), interlobular septal thickening, and fibrosis) and (2) in the pleura (thickening, effusion, and pneumothorax). Interobserver agreement between the two reviewers was evaluated by the proportion of agreement and the Kappa statistic. Results: The final study population consisted of 64 pediatric patients (36 males (56.3%) and 43 females (43.7%); mean age, 1.7 years; range, 1 day–17 years). Among these 64 patients, 19 patients (29.7%) comprised Group 1 and the remaining 45 patients (70.3%) comprised Group 2. In Group 1 (children with PVS with aspiration), the detected lung and pleural MDCT abnormalities were: GGO (17/19; 89.5%), pleural thickening (17/19; 89.5%), consolidation (16/19; 84.5%), and septal thickening (16/19; 84.5%). The lung and pleural MDCT abnormalities observed in Group 2 (children with PVS without aspiration) were: GGO (37/45; 82.2%), pleural thickening (37/45; 82.2%), septal thickening (36/45; 80%), consolidation (3/45; 6.7%), pleural effusion (1/45; 2.2%), pneumothorax (1/45; 2.2%), and cyst(s) (1/45; 2.2%). Consolidation was significantly more common in pediatric patients with both PVS and aspiration (Group 1) (p < 0.001). There was high interobserver agreement between the two independent reviewers for detecting lung and pleural abnormalities on thoracic MDCT studies (Kappa = 0.98; CI = 0.958, 0.992). Conclusion: Aspiration is common in pediatric patients with PVS who undergo MDCT and was present in nearly 30% of all children with PVS during our study period. Consolidation is not a typical radiologic finding of PVS in children without clinical evidence of aspiration. When consolidation is present on thoracic MDCT studies in pediatric patients with PVS, the additional diagnosis of concomitant aspiration should be considered.

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Extravascular MDCT Findings of Pulmonary Vein Stenosis in Children with Cardiac Septal Defect

Cited by 3 publications

References 26 publications

Pleuropulmonary MDCT Findings: Comparison between Children with Pulmonary Vein Stenosis and Prematurity-Related Lung Disease

Pleuropulmonary MDCT Findings: Comparison between Children with Pulmonary Vein Stenosis and Prematurity-Related Lung Disease

Computed tomographic parenchymal lung findings in premature infants with pulmonary vein stenosis

Lung and Pleural Findings of Children with Pulmonary Vein Stenosis with and without Aspiration: MDCT Evaluation

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