Pulmonary Arteriography

Mediastinum: heart & great vessels

Superior & inferior vena cava: Rt atrium

Ascending, descending, & arch of aorta: (Lt ventricle)

Pulmonary trunk: (Rt ventricle)

Pulmonary veins: Lt atrium

Rt & Lt pulmonary arteries(lobar and segmental branches)

Atlas of Human Anatomy Second edition (201)

Mediastinum: heart& great vessels

Superior vena cava(to Rt atrium)

Ascending, descending,& arch of aorta (fromLt ventricle)

Pulmonary trunk (from Rt ventricle)

Rt and Lt hemidiaphragm(domes of)

Radiographic Anatomy of PA Chest

Right pulmonaryartery

Left pulmonaryartery

Pulmonarytrunk

Pulmonary Arteriography

Indications

* Chest pain* Dyspnea* SOB* Pulmonary emboli* Pumonary stenosis* Patent ductus arteriosis

Contraindications

* Cardiac dysrhythmias* PVCs* Pulmonary edema (rales)* Pulmonary hypertension (mean > 60mmHg vs normal of 15)

Approaches for Pulmonary Arteriography

* Femoral vein unless contraindicated by thrombi* Axillary vein* Antecubital vein: peripheral using DSA * Antecubital vein cutdown (Right arm in abduction, valsalva maneuver)

Equipment for Pulmonary Arteriography

* 6-7 f Grollman pigtail catheter* Side and end, or just side holes with sheath** .038 J, moveable core GW* 12 – 16 gauge needle for venous stick

Shape of the Grollman catheter

* A catheter without an end hole has less recoil during injection, buta guidewire cannot be used with it, so a long sheath is placed in position, and the catheter is introduced through it.

Pulmonary Trunk Pressure

Pressure in the rightor left pulmonaryarteries, though slightly higher, issimilar to that in the trunk vessel.

T TP

Q

R

S

Systole Diastole

mm Hg

10

5

20

15

Pulmonary hypertension60 mmHg

Pulmonary artery: mean 9-17Systolic 15-30, Diastolic 4-14

NG tube ET tubeSwan-Ganz catheter:

For taking pressures in thepulmonary artery, and monitoringoxygen saturation. Note its appearance in the LPO position

Filming Pulmonary Arteriograms

Right Pulmonary artery

Left Pulmonary artery

AP projection of pulmonary trunk injection

Filming Pulmonary Arteriograms

AP projection of selected right pulmonary artery

10-15 degrees LPO position for Rt Pulmonary A

Filming Pulmonary Arteriograms

Filming Pulmonary Arteriograms

RPO position for Lt Pulmonary A30-45 degrees

Filming Pulmonary Arteriograms

A 60 degree LPO of the leftpulmonary artery

Scout film

Pulmonary Stenosis

Pulmonary valve is narrow, blocking adequate blood flow to the lungs.

Pulmonary Stenosis Signs and Symptoms:

• SOB• fatigue• cyanosis• chest pain• failure to thrive in infants• inability to tolerate exercise• CHF and sudden death

Pulmonary Stenosis: Congenital Etiology (Idiopathic)

* Occurs during fetal development* Common with other heart defects

Non congenital causes

* Rheumatic Fever* Endocarditis

Treatment options

Pulmonary valvuloplastyOpen heart surgery

Pulmonary Emboli (PE)This Greenfield caval filter is in the inferior vena cava. It is introduced through the rightinternal jugular or femoral vein

If the filter were not present, clots would travel to the right heart, pulmonary artery, and the arterioles of the lungs. Such filters are commonly impregnatedwith a thrombolytic agent, and once implanted, are not removed.

Other types of caval filters are thebird’s Nest, Vena Tech LGM and LP, Simon Nitinol and TrapeEase.