Computed tomography angiography for presence of systemic-to-pulmonary artery shunt in transpleural systemic arterial supply

  • Yi-fan Zhang
    Corresponding author at: Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
    Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
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  • Qiong Zhao
    Department of Ultrasound, The Fifth Hospital in Wuhan, Wuhan, 430050, China
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  • Rui Huang
    Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
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      • RSPAS can be detected in patients with transpleural systemic arterial supply.
      • RSPAS includes enlarged and multiple systemic arteries.
      • Patients with RSPAS may have greater risk of hemoptysis.
      • Delay scanning is necessary for RSPAS on chest CTA.



      To investigate radiographic indications and relevant clinical symptoms of retrograde systemic-to-pulmonary artery shunt (RSPAS).


      Forty-six consecutive patients, with transpleural systemic arterial supply to the lung confirmed by surgery or conventional angiography, underwent chest computed tomography angiography (CTA). Patients with the finding of RSPAS in CT scans were compared with those among whom no retrograde systemic-to-pulmonary artery shunt (NRSPAS) was present. Differences in clinical features, distribution and diameters of systemic supplying arteries between RSPAS and NRSPAS were assessed.


      RSPAS in twenty patients (8 left and 12 right) and NRSPAS in 26 patients (14 left and 12 right) were detected at CTA. Hemoptysis and sputum were more frequent in RSPAS (85 % and 60 %, respectively) than in NRSPAS (46 % and 31 %, respectively) (P < 0.05). Single systemic supplying artery was more common in NRSPAS (65 %) while multiple systemic arteries were more frequent in RSPAS (65 %) (P < 0.05). The mean diameter of systemic arteries (6.13 ± 0.57 mm) in RSPAS was significantly larger than that (4.26 ± 0.55 mm) in NRSPAS (P < 0.0001). The anatomic location of systemic arteries crossing the thickened pleura distributed more intensively in apical and costal pleura in RSPAS than that in NRSPAS (P < 0.05). The distribution of systemic arteries adjacent to left or right lung was not statistically significant between RSPAS and NRSPAS.


      Radiographic features of RSPAS are different from NRSPAS. RSPAS may include enlarged and multiple systemic supplying arteries. And that may suggest greater risk of hemoptysis.


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