Anomalous systemic arterial supply to the lungs has been extensively described in association with other congenital abnormalities such as bronchopulmonary sequestration and hypogenetic lung syndrome (scimitar syndrome). In 1946, Pryce introduced the term ‘sequestration’ to describe congenital abnormalities characterised by an anomalous systemic arterial supply to the lung and atresia or hypoplasia of the pulmonary artery. Sequestration was defined by Pryce as a “disconnected (dislocated, ectopic) bronchopulmonary mass or cyst with an anomalous systemic blood supply”.
Since Pryce’s early description of sequestration, a wide spectrum of bronchopulmonary- vascular malformations have been recognised, many of which do not fulfil the original definition. Our case differs from traditional descriptions of sequestration, in that a portion of normal lung receives an anomalous systemic blood supply. Sade et al. proposed the concept of a sequestration spectrum, in order to encompass and describe the various combinations of abnormal bronchial connection, arterial supply and venous drainage. As a similar spectrum concept, Clements and Warner introduced a simple descriptive anatomical approach to such complex bronchopulmonary-vascular malformations named ‘pulmonary malinosculation spectrum’.
Systemic arterialization of the lung without pulmonary sequestration is the rarest form of anomalous systemic arterial supply to the lung . This condition is characterised by an aberrant systemic arterial branch, most commonly arising from the thoracic portion of the descending aorta or the abdominal aorta, supplying an area of lung parenchyma with normal bronchopulmonary system. The left lower lobe is most often involved, and there is commonly an atr...
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... Various treatment modalities have been described, including lobectomy or segmentectomy, systemic artery to pulmonary artery anastomosis and endovascular treatment. Differentiation between this condition from classic sequestration has important treatment implications as it may allow non-operative management (angiographic embolization) of the aberrant systemic artery.
TEACHING POINT
Systemic arterialization of the lung without sequestration is a rare condition often diagnosed following investigation of an incidental cardiac murmur or based on abnormal chest X ray or CT of the thorax, as most patients are asymptomatic. Thoracic CT is the most useful diagnostic test as it demonstrates both the bronchial and vascular anatomy of the lung while CT angiography can clearly depict the origin of the aberrant systemic artery, avoiding invasive techniques for the diagnosis.
R.S.’s clinical findings as a consequence of his chronic bronchitis are likely to include: being overweight, experiencing shortness of breath on exertion, producing excessive amount of sputum, having a chronic productive cough, as well as edema and hypervolemia just to name a few. (Copstead & Banasik, 548) Some of these signs and symptoms would be different if R.S. had emphysematous COPD. In emphysema (or “pink puffers”), there is weight loss, the cough is absent or negligible, and edema is not present. While central cyanosis and jugular vein distention are present in late chronic bronchitis, these pathologic manifestations are absent in emphysema. . (Copstead & Banasik, 549)
In more severe cases, a surgical procedure known as endarterectomy is suggested. An edarterectomy is an operation used to widen the carotid artery. This is usually an option if it has been determined that the internal carotid artery is narrowed by more than 70% and if the person in question has been displaying stroke-like symptoms during the previous six to eight months. This surgery is usually used to prevent the future risk of a stroke. This procedure has been shown to prevent blockage of the internal carotid artery over time and usually involves removing fatty deposits and clots in this important artery.
Mrs. Jones, An elderly woman, presented severely short of breath. She required two rest periods in order to ambulate across the room, but refused the use of a wheel chair. She was alert and oriented, but was unable to speak in full sentences. Her skin was pale and dry. Her vital signs were as follows: Temperature 97.3°F, pulse 83, respirations 27, blood pressure 142/86, O2 saturation was 84% on room air. Auscultation of the lungs revealed crackles in the lower lobes and expiratory wheezing. Use of accessory muscles was present. She was put on 2 liters of oxygen via nasal canal. With the oxygen, her O2 saturation increased to 90%. With exertion her O2 saturation dropped to the 80's. Mrs. Jones began coughing and she produced large amounts of milky sputum.
Following subsequent investigations, she was diagnosed with bilateral pneumonia and empyema, and was admitted. Once stabilized, she underwent a left thoracotomy with decortication. As a result 2 drains were inserted, with each draining serosanguinous fluid. The plan is to remove these once they have drained < 20 ml in 24 hours.
A pneumothorax is defined as “the presence of air or gas in the plural cavity which can impair oxygenation and/or ventilation” (Daley, 2014). The development of a pneumothorax to a tension pneumothorax can be caused from positive pressure ventilation.
Person, A. & Mintz, M., (2006), Anatomy and Physiology of the Respiratory Tract, Disorders of the Respiratory Tract, pp. 11-17, New Jersey: Human Press Inc.
The clinical manifestation one may see in patients with chronic bronchitis are chronic cough, weight loss, excessive sputum, and dyspnea. Chronic cough is from the body trying to expel the excessive mucus build up to return breathing back to normal. Dyspnea is from the thickening of the bronchial walls causing constriction, thereby altering the breathing pattern. This causes the body to use other surrounding muscles to help with breathing which can be exhausting. These patients ca...
A PE usually begins as a clot in a deep vein of the leg, which is called deep vein thrombosis. This clot can break and travel through the bloodstream to the lungs and block the artery. Blood clots can form in the deep veins of the legs if blood flow is restricted and slows down. This can occur when you don’t move around for long periods of time. Some examples that can cause this are some types of surgery, during a long trip in a car or airplane, and if you must stay in bed for an extended period of time. Under rare circumstances an air bubble, part of tumor, or other tissue travels to lungs and causes ...
Parker, Steve. "Chronic Pulmonary Diseases." The Human Body Book. New ed. New York: DK Pub., 2007.
I complained so much about my golf game that my wife bought me a golf psychology book for my birthday. I figured I would give it a shot, because after all, it couldn't hurt. According to the book, I have subconsciously imposed limits on myself that prevents success. There are tests and quizzes to help me identify the mental barriers and irrational beliefs that keep me from winning. Through mental exercises and meditation I was able to overcome these unhealthy mental blocks and start playing some of the best golf of my life. Wh...
You work like hell. But you learn a lot.” In my experience, I have learned a lot but the most important thing that I have learned is forgiving myself on the golf course; forgiving myself on the shots I do bad on or have a bad round. I tell myself that I will do better next time. Golf is as big as a mental game as it is a physical game. For example, I was at the biggest golf match of my junior year. I started the first hole off with going straight into the woods; as a result, I had to take a stroke. This patterned seemed to continue throughout the first nine holes. As I was eating lunch in between holes I realized what I was going wrong this whole time. I was thinking about my first hit; however, all I needed to do was forget about it. ……….. In conclusion, I got second place in district continuing to sectionals. Regardless of all the thoughts in my head. Forgetting about them made it a lot easier to enjoy the game and to play a good round. As a golfer, I’m thankful to have gained this quality as a life lesson not just on the golf
...lood Vessel Stents.” 1-3). Bypass surgery is another option; a blood vessel from somewhere in the body is used to go around the blocked artery. This completely bypasses the blocked artery, so it no longer becomes an issue. Thrombolytic therapy is a method that involves injecting a medication into the artery that will dissolve the clot and allow blood to pass freely through the artery (“Peripheral Artery Disease.” 3).
Students learn many different lessons while participating in school activities and competing on athletic teams. Sportsmanship, determination, time management, holding yourself accountable, and trusting yourself are some important lessons that I experienced and took away from my time being on the golf team at my school for four years. One of the most significant lessons that the game of golf taught me was to always have the desire to learn and better yourself. A person can never be done learning because there will always be new skills to learn and old skills to improve upon. I love and value learning and believe that it is necessary to strive to be a life long learner.
Ventricular septal defect, where the septum has a “hole”, allowing blood to mix which creates dysfunctions within. The Overriding Aorta is that of which the aorta is between the left and ventricles, whereas in a healthy heart, the aorta is attached to the left ventricle. Pulmonary stenosis is where the pulmonary valve is much smaller, causing a lack of blood flow. The Right Ventricular Hypertrophy is where the muscle of the right ventricle is more rampant than it would be in a healthy heart, again causing an anomaly in blood flow.(NIH, 2011). These defects makeup TOF and show differences in the blood flow and abnormal pressures in the heart in different ways. In most cases, a child undergoing TOF will be seen as cyanotic, or a blue color due to lack of oxygen. This is because blood that lacks oxygen is darker, therefore making the child seem as though they are “tinted” blue. (Cincinnati Children’s H., 2015) After a child with Tetralogy of Fallot is born, measures must be taken almost immediately to insure that this lack of blood flow is aided in some