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Hemodynamic Effects of Monomeric Nonionic Contrast Media in Pulmonary Angiography in Chronic Thromboembolic Pulmonary Hypertension

Michael B. Pitton1, Gunter Kemmerich1, Sascha Herber1, Eckhard Mayer2, Manfred Thelen1 and Christoh Düber1

1 Department of Radiology, University Hospital of Mainz, Langenbeckstr. 1, Mainz, Germany 55131.
2 Department of Cardiothoracic Surgery, University Hospital of Mainz, Mainz, Germany.


Figure 1
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Fig. 1 22-year-old woman with primary pulmonary hypertension. Pulmonary angiography with digital subtraction angiography technique; complete digital subtraction without anatomic background, posteroanterior projection. No evidence for chronic thromboembolic deposits is seen.

 

Figure 2
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Fig. 2A 36-year-old man with angiographic findings of moderate thromboembolic deposits in chronic thromboembolic pulmonary hypertension. Right anterior oblique (20°) and lateral projections of right pulmonary artery. Thromboembolic deposits are shown by irregularities in main artery and in segmental arteries (arrows), abrupt diameter reduction (arrowhead, A), and pouching (asterisk, B).

 

Figure 3
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Fig. 2B 36-year-old man with angiographic findings of moderate thromboembolic deposits in chronic thromboembolic pulmonary hypertension. Right anterior oblique (20°) and lateral projections of right pulmonary artery. Thromboembolic deposits are shown by irregularities in main artery and in segmental arteries (arrows), abrupt diameter reduction (arrowhead, A), and pouching (asterisk, B).

 

Figure 4
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Fig. 2C 36-year-old man with angiographic findings of moderate thromboembolic deposits in chronic thromboembolic pulmonary hypertension. Posteroanterior projection of right pulmonary artery shows bands (arrow), abrupt diameter reductions (arrowhead), and webs (asterisk).

 

Figure 5
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Fig. 2D 36-year-old man with angiographic findings of moderate thromboembolic deposits in chronic thromboembolic pulmonary hypertension. Posteroanterior projection of left pulmonary artery, complete subtraction without anatomic background, late phase. All segmental arteries have no parenchymal staining with one exception (arrow). Occlusion is seen in all basal segmental arteries with one exception.

 

Figure 6
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Fig. 3A 69-year-old woman with angiographic findings of severe thromboembolic deposits in chronic thromboembolic pulmonary hypertension. Posteroanterior and lateral projections of right pulmonary artery show peripheral thromboembolic occlusion of subsegmental arteries of various sizes, particularly in lower lobe arteries (arrows).

 

Figure 7
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Fig. 3B 69-year-old woman with angiographic findings of severe thromboembolic deposits in chronic thromboembolic pulmonary hypertension. Posteroanterior and lateral projections of right pulmonary artery show peripheral thromboembolic occlusion of subsegmental arteries of various sizes, particularly in lower lobe arteries (arrows).

 

Figure 8
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Fig. 3C 69-year-old woman with angiographic findings of severe thromboembolic deposits in chronic thromboembolic pulmonary hypertension. Lateral projection of left pulmonary artery shows complete occlusion of lower lobe artery (arrow). Perfusion is preserved in upper lobe and lingula arteries.

 

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