Parenchymal Changes in HPS

These images are from the 64-year-old woman with alcoholic cirrhosis. One lung was perfused with barium-gelatin via the pulmonary artery.

pulmvein

Figure 1. Bronchial to Pulmonary Vascular Anastomosis

Here the barium is seen in bronchial vessels around a bronchiole, indicating open pulmonary artery to bronchial artery anastomosis. Anastomosis of a venous bronchial channel to a pulmonary vein is seen. The pulmonary artery accompanying the bronchiole lies at the lower right. This type of precapillary arteriovenous anastomosis, a type II lesion, would constitute a true shunt not correctable by breathing 100% oxygen.

Find the pulmonary vein that is anastomosed to the bronchial vein.

supernum

Figure 2. Supernumerary Artery Filling

Another section from the same lung shows dichotomous branching of an artery. At its lower left is a branch at right angles, a supernumerary artery, which is filled with barium. Normally, these branches do not fill with barium. This dilation may contribute to the lower lobe opacities seen on radiographs in these patients, as well as to their orthodeoxia and platypnea.

Find the supernumerary artery branch.

intima1intima2

Figure 3. Arterial Intimal Fibrosis

In addition to venous and capillary intimal thickening, arteries also showed focal intimal thickening. The significance of this change is unknown. Note the internal and external elastic layers of the arterial wall media. Elastic van Gieson stain

Find the thickened intima in the artery in the center of the image.

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Pulmonary vein anastomosed to bronchial vein

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Supernumerary artery branch

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Thickened intima and narrowed lumen

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