PMC9421389_01
CT-thorax demonstrating enlarged and tortuous arteries.
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An arterial phase CT-thorax with contrast showed a markedly enlarged main bronchial artery with numerous enlarged, tortuous mediastinal bronchial arteries, a large abnormal blood supply arising from the right subclavian artery and that his SVC stents were patent (Fig. 1a and b). Fig. 1A displays a coronal thick Maximum Intensity Projection (MIP) image from the patient's initial CT-thorax. Fig. 1B also displays a thick MIP image from the patient's initial CT-thorax and highlights a separate grossly enlarged artery originating from the right subclavian artery.
CT-thorax highlighting the lung windows.
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The scan also highlighted the patient's extensive lung disease secondary to his CF (Fig. 2). Fig. 2 is an image taken from the patient's initial CT-thorax highlighting the lung windows.
Collateral vessels connecting the bronchial and right subclavian artery networks.
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The interventional radiology team was able to identify a connection between the bronchial circulation and a vessel that most likely originated from the right subclavian artery and supplies the apex of the right lung (Fig. 3). Fig. 3 shows the microcatheter inserted within the main bronchial trunk and contrast being injected into the bronchial artery system.
Ct head imaging showing obstructive hydrocephalus.
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An urgent CT head (Fig. 4A) demonstrated a large infarct measuring 32mm x 32mm x 22mm in the right cerebellar hemisphere as well as three smaller but nevertheless extensive infarcts in the left cerebellar hemisphere. A repeat CT-head (Fig. 4B) showed progressive dilatation of the supratentorial ventricular systems associated with trapped temporal horns. Fig. 4A displays an image of the lateral ventricles and surrounding cerebral cortex and subcortical areas taken from the patient's initial CT head. Fig. 4B displays a CT image from the same region of the brain 24 hours later following a decline in his Glasgow Come Scale. Fig. 4A demonstrates no evidence of disruption of the supratentorial ventricular system whereas Fig. 4B shows that the lateral ventricles became significantly more dilated, especially within the temporal horns. The trapping of CSF within the temporal horns seen in Fig. 4B suggests that the patient developed obstructive hydrocephalus, most likely as a complication of the multiple infarcts in the cerebellum, occipital lobes and right caudate nucleus.