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Published in: Insights into Imaging 6/2018

Open Access 01-12-2018 | Pictorial Review

Pictorial review of the pulmonary vasculature: from arteries to veins

Authors: Thomas J. Marini, Kevin He, Susan K. Hobbs, Katherine Kaproth-Joslin

Published in: Insights into Imaging | Issue 6/2018

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Abstract

Pathology of the pulmonary vasculature involves an impressive array of both congenital and acquired conditions. While some of these disorders are benign, disruption of the pulmonary vasculature is often incompatible with life, making these conditions critical to identify on imaging. Many reviews of pulmonary vascular pathology approach the pulmonary arteries, pulmonary veins and bronchial arteries as individual topics. The goal of this review is to provide an integrated overview of the high-yield features of all major disorders of the pulmonary vasculature. This approach provides a more cohesive and comprehensive conceptualisation of respiratory pathology. In this review, we present both the salient clinical and imaging features of congenital and acquired disorders of the pulmonary vasculature, to assist the radiologist in identifying pathology and forming a robust differential diagnosis tailored to the presenting patient.

Teaching Points

Abnormalities of the pulmonary vasculature are both congenital and acquired.
Pathology of a single pulmonary vascular territory often affects the entire pulmonary vasculature.
Anomalous pulmonary venous flow is named as a function of its location and severity.
Bronchial arteries often undergo dilatation secondary to cardio-respiratory pathology.
Literature
1.
go back to reference Castañer E, Gallardo X, Rimola J et al (2006) Congenital and acquired pulmonary artery anomalies in the adult: radiologic overview. Radiographics 26:349–371CrossRef Castañer E, Gallardo X, Rimola J et al (2006) Congenital and acquired pulmonary artery anomalies in the adult: radiologic overview. Radiographics 26:349–371CrossRef
2.
go back to reference Porres DV, Morenza OP, Pallisa E, Roque A, Andreu J, Martinez M (2013) Learning from the pulmonary veins. Radiographics 33:999–1022CrossRef Porres DV, Morenza OP, Pallisa E, Roque A, Andreu J, Martinez M (2013) Learning from the pulmonary veins. Radiographics 33:999–1022CrossRef
3.
go back to reference Dillman JR, Yarram SG, Hernandez RJ (2009) Imaging of pulmonary venous developmental anomalies. AJR Am J Roentgenol 192:1272–1285CrossRef Dillman JR, Yarram SG, Hernandez RJ (2009) Imaging of pulmonary venous developmental anomalies. AJR Am J Roentgenol 192:1272–1285CrossRef
4.
go back to reference Khadir MM, Chaturvedi A, Nguyen MS, Wandtke JC, Hobbs S, Chaturvedi A (2014) Looking beyond the thrombus: essentials of pulmonary artery imaging on CT. Insights Imaging 5:493–506CrossRef Khadir MM, Chaturvedi A, Nguyen MS, Wandtke JC, Hobbs S, Chaturvedi A (2014) Looking beyond the thrombus: essentials of pulmonary artery imaging on CT. Insights Imaging 5:493–506CrossRef
5.
go back to reference Walker CM, Rosado-de-Christenson ML, Martínez-Jiménez S, Kunin JR, Wible BC (2015) Bronchial arteries: anatomy, function, hypertrophy, and anomalies. Radiographics 35:32–49CrossRef Walker CM, Rosado-de-Christenson ML, Martínez-Jiménez S, Kunin JR, Wible BC (2015) Bronchial arteries: anatomy, function, hypertrophy, and anomalies. Radiographics 35:32–49CrossRef
6.
go back to reference Ryu DS, Spirn PW, Trotman-Dickenson B et al (2004) HRCT findings of proximal interruption of the right pulmonary artery. J Thorac Imaging 19:171–175CrossRef Ryu DS, Spirn PW, Trotman-Dickenson B et al (2004) HRCT findings of proximal interruption of the right pulmonary artery. J Thorac Imaging 19:171–175CrossRef
7.
go back to reference Zylak CJ, Eyler WR, Spizarny DL, Stone CH (2002) Developmental lung anomalies in the adult: radiologic-pathologic correlation. Radiographics 22(Spec No):S25–S43 Zylak CJ, Eyler WR, Spizarny DL, Stone CH (2002) Developmental lung anomalies in the adult: radiologic-pathologic correlation. Radiographics 22(Spec No):S25–S43
8.
go back to reference Ring NJ, Marshall AJ (2002) Idiopathic dilatation of the pulmonary artery. Br J Radiol 75:532–535CrossRef Ring NJ, Marshall AJ (2002) Idiopathic dilatation of the pulmonary artery. Br J Radiol 75:532–535CrossRef
9.
go back to reference Truong QA, Massaro JM, Rogers IS et al (2012) Reference values for normal pulmonary artery dimensions by noncontrast cardiac computed tomography: the Framingham heart study. Circ Cardiovasc Imaging 5:147–154CrossRef Truong QA, Massaro JM, Rogers IS et al (2012) Reference values for normal pulmonary artery dimensions by noncontrast cardiac computed tomography: the Framingham heart study. Circ Cardiovasc Imaging 5:147–154CrossRef
10.
go back to reference Peña E, Dennie C, Veinot J, Muñiz SH (2012) Pulmonary hypertension: how the radiologist can help. Radiographics 32:9–32CrossRef Peña E, Dennie C, Veinot J, Muñiz SH (2012) Pulmonary hypertension: how the radiologist can help. Radiographics 32:9–32CrossRef
11.
go back to reference Galiè N, Humbert M, Vachiery JL et al (2016) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 37:67–119CrossRef Galiè N, Humbert M, Vachiery JL et al (2016) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 37:67–119CrossRef
12.
go back to reference Simonneau G, Gatzoulis MA, Adatia I et al (2014) [Updated clinical classification of pulmonary hypertension]. Turk Kardiyol Dern Ars 42(Suppl 1):45–54 Simonneau G, Gatzoulis MA, Adatia I et al (2014) [Updated clinical classification of pulmonary hypertension]. Turk Kardiyol Dern Ars 42(Suppl 1):45–54
13.
go back to reference Grosse C, Grosse A (2010) CT findings in diseases associated with pulmonary hypertension: a current review. Radiographics 30:1753–1777CrossRef Grosse C, Grosse A (2010) CT findings in diseases associated with pulmonary hypertension: a current review. Radiographics 30:1753–1777CrossRef
14.
go back to reference Yi CA, Lee KS, Choe YH, Han D, Kwon OJ, Kim S (2004) Computed tomography in pulmonary artery sarcoma: distinguishing features from pulmonary embolic disease. J Comput Assist Tomogr 28:34–39CrossRef Yi CA, Lee KS, Choe YH, Han D, Kwon OJ, Kim S (2004) Computed tomography in pulmonary artery sarcoma: distinguishing features from pulmonary embolic disease. J Comput Assist Tomogr 28:34–39CrossRef
15.
go back to reference Rossi SE, McAdams HP, Rosado-de-Christenson ML, Franks TJ, Galvin JR (2001) Fibrosing mediastinitis. Radiographics 21:737–757CrossRef Rossi SE, McAdams HP, Rosado-de-Christenson ML, Franks TJ, Galvin JR (2001) Fibrosing mediastinitis. Radiographics 21:737–757CrossRef
16.
go back to reference Gotway MB, Araoz PA, Macedo TA et al (2005) Imaging findings in Takayasu's arteritis. AJR Am J Roentgenol 184:1945–1950CrossRef Gotway MB, Araoz PA, Macedo TA et al (2005) Imaging findings in Takayasu's arteritis. AJR Am J Roentgenol 184:1945–1950CrossRef
17.
go back to reference Han D, Lee KS, Franquet T et al (2003) Thrombotic and nonthrombotic pulmonary arterial embolism: spectrum of imaging findings. Radiographics 23:1521–1539CrossRef Han D, Lee KS, Franquet T et al (2003) Thrombotic and nonthrombotic pulmonary arterial embolism: spectrum of imaging findings. Radiographics 23:1521–1539CrossRef
18.
go back to reference Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard JA, McLoud TC (2004) CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics 24:1219–1238CrossRef Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard JA, McLoud TC (2004) CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics 24:1219–1238CrossRef
19.
go back to reference Castañer E, Gallardo X, Ballesteros E et al (2009) CT diagnosis of chronic pulmonary thromboembolism. Radiographics 29:31–50 discussion 50–53CrossRef Castañer E, Gallardo X, Ballesteros E et al (2009) CT diagnosis of chronic pulmonary thromboembolism. Radiographics 29:31–50 discussion 50–53CrossRef
20.
go back to reference Lacomis JM, Goitein O, Deible C, Schwartzman D (2007) CT of the pulmonary veins. J Thorac Imaging 22:63–76CrossRef Lacomis JM, Goitein O, Deible C, Schwartzman D (2007) CT of the pulmonary veins. J Thorac Imaging 22:63–76CrossRef
21.
go back to reference Agarwal PP, Seely JM, Matzinger FR (2004) MDCT of anomalous unilateral single pulmonary vein. AJR Am J Roentgenol 183:1241–1243CrossRef Agarwal PP, Seely JM, Matzinger FR (2004) MDCT of anomalous unilateral single pulmonary vein. AJR Am J Roentgenol 183:1241–1243CrossRef
22.
go back to reference Vyas HV, Greenberg SB, Krishnamurthy R (2012) MR imaging and CT evaluation of congenital pulmonary vein abnormalities in neonates and infants. Radiographics 32:87–98CrossRef Vyas HV, Greenberg SB, Krishnamurthy R (2012) MR imaging and CT evaluation of congenital pulmonary vein abnormalities in neonates and infants. Radiographics 32:87–98CrossRef
23.
go back to reference Demos TC, Posniak HV, Pierce KL, Olson MC, Muscato M (2004) Venous anomalies of the thorax. AJR Am J Roentgenol 182:1139–1150CrossRef Demos TC, Posniak HV, Pierce KL, Olson MC, Muscato M (2004) Venous anomalies of the thorax. AJR Am J Roentgenol 182:1139–1150CrossRef
24.
go back to reference Ferguson EC, Krishnamurthy R, Oldham SA (2007) Classic imaging signs of congenital cardiovascular abnormalities. Radiographics 27:1323–1334CrossRef Ferguson EC, Krishnamurthy R, Oldham SA (2007) Classic imaging signs of congenital cardiovascular abnormalities. Radiographics 27:1323–1334CrossRef
25.
go back to reference ElBardissi AW, Dearani JA, Suri RM, Danielson GK (2008) Left-sided partial anomalous pulmonary venous connections. Ann Thorac Surg 85:1007–1014CrossRef ElBardissi AW, Dearani JA, Suri RM, Danielson GK (2008) Left-sided partial anomalous pulmonary venous connections. Ann Thorac Surg 85:1007–1014CrossRef
26.
go back to reference Kamijoh M, Itoh M, Kijimoto C, Nagakura T, Okabe T (2002) Horseshoe lung with bilateral vascular anomalies: a rare variant of hypogenetic lung syndrome (scimitar syndrome). Pediatr Int 44:443–445CrossRef Kamijoh M, Itoh M, Kijimoto C, Nagakura T, Okabe T (2002) Horseshoe lung with bilateral vascular anomalies: a rare variant of hypogenetic lung syndrome (scimitar syndrome). Pediatr Int 44:443–445CrossRef
27.
go back to reference Vanherreweghe E, Rigauts H, Bogaerts Y, Meeus L (2000) Pulmonary vein varix: diagnosis with multi-slice helical CT. Eur Radiol 10:1315–1317CrossRef Vanherreweghe E, Rigauts H, Bogaerts Y, Meeus L (2000) Pulmonary vein varix: diagnosis with multi-slice helical CT. Eur Radiol 10:1315–1317CrossRef
28.
go back to reference Lee EY, Boiselle PM, Cleveland RH (2008) Multidetector CT evaluation of congenital lung anomalies. Radiology 247:632–648CrossRef Lee EY, Boiselle PM, Cleveland RH (2008) Multidetector CT evaluation of congenital lung anomalies. Radiology 247:632–648CrossRef
29.
go back to reference Pourmoghadam KK, Moore JW, Khan M et al (2003) Congenital unilateral pulmonary venous atresia: definitive diagnosis and treatment. Pediatr Cardiol 24:73–79CrossRef Pourmoghadam KK, Moore JW, Khan M et al (2003) Congenital unilateral pulmonary venous atresia: definitive diagnosis and treatment. Pediatr Cardiol 24:73–79CrossRef
30.
go back to reference Latson LA, Prieto LR (2007) Congenital and acquired pulmonary vein stenosis. Circulation 115:103–108CrossRef Latson LA, Prieto LR (2007) Congenital and acquired pulmonary vein stenosis. Circulation 115:103–108CrossRef
31.
go back to reference Lin MT, Ku SC, Wu MZ, Yu CJ (2008) Intracardiac extension of lung cancer via the pulmonary vein. Thorax 63:1122CrossRef Lin MT, Ku SC, Wu MZ, Yu CJ (2008) Intracardiac extension of lung cancer via the pulmonary vein. Thorax 63:1122CrossRef
32.
go back to reference Pazos-López P, García-Rodríguez C, Guitián-González A (2016) Pulmonary vein stenosis: etiology, diagnosis and management. World J Cardiol 8:81–88 Pazos-López P, García-Rodríguez C, Guitián-González A (2016) Pulmonary vein stenosis: etiology, diagnosis and management. World J Cardiol 8:81–88
33.
go back to reference Cavaco RA, Kaul S, Chapman T et al (2009) Idiopathic pulmonary fibrosis associated with pulmonary vein thrombosis: a case report. Cases J 2:9156CrossRef Cavaco RA, Kaul S, Chapman T et al (2009) Idiopathic pulmonary fibrosis associated with pulmonary vein thrombosis: a case report. Cases J 2:9156CrossRef
34.
go back to reference Nelson E, Klein JS (2000) Pulmonary infarction resulting from metastatic osteogenic sarcoma with pulmonary venous tumor thrombus. AJR Am J Roentgenol 174:531–533CrossRef Nelson E, Klein JS (2000) Pulmonary infarction resulting from metastatic osteogenic sarcoma with pulmonary venous tumor thrombus. AJR Am J Roentgenol 174:531–533CrossRef
36.
go back to reference Gilkeson RC, Nyberg EM, Sachs PB, Wiant AM, Zahka KG, Siwik ES (2008) Systemic to pulmonary venous shunt: imaging findings and clinical presentations. J Thorac Imaging 23:170–177CrossRef Gilkeson RC, Nyberg EM, Sachs PB, Wiant AM, Zahka KG, Siwik ES (2008) Systemic to pulmonary venous shunt: imaging findings and clinical presentations. J Thorac Imaging 23:170–177CrossRef
37.
go back to reference Kapur S, Paik E, Rezaei A, Vu DN (2010) Where there is blood, there is a way: unusual collateral vessels in superior and inferior vena cava obstruction. Radiographics 30:67–78CrossRef Kapur S, Paik E, Rezaei A, Vu DN (2010) Where there is blood, there is a way: unusual collateral vessels in superior and inferior vena cava obstruction. Radiographics 30:67–78CrossRef
38.
go back to reference Montani D, Price LC, Dorfmuller P et al (2009) Pulmonary veno-occlusive disease. Eur Respir J 33:189–200CrossRef Montani D, Price LC, Dorfmuller P et al (2009) Pulmonary veno-occlusive disease. Eur Respir J 33:189–200CrossRef
39.
go back to reference Koroglu M, Chen PS, Oto A, Koroglu BK (2005) Left atrial, pulmonary vein and dural calcification in a patient with arrhythmia and chronic renal failure. JBR-BTR 88:78–79PubMed Koroglu M, Chen PS, Oto A, Koroglu BK (2005) Left atrial, pulmonary vein and dural calcification in a patient with arrhythmia and chronic renal failure. JBR-BTR 88:78–79PubMed
40.
go back to reference Ruvolo G, Greco E, Speziale G, Mercogliano D, Marino B (1994) “Mold-like” calcification of the left atrium and of the pulmonary veins. Total endoatriectomy in a patient undergoing mitral valve replacement. Eur J Cardiothorac Surg 8:54–55CrossRef Ruvolo G, Greco E, Speziale G, Mercogliano D, Marino B (1994) “Mold-like” calcification of the left atrium and of the pulmonary veins. Total endoatriectomy in a patient undergoing mitral valve replacement. Eur J Cardiothorac Surg 8:54–55CrossRef
41.
go back to reference Morgan GJ, Qureshi SA (2016) The diagnosis and interventional management of pulmonary arteriovenous malformations. EuroIntervention 12(Suppl X):X24–X27CrossRef Morgan GJ, Qureshi SA (2016) The diagnosis and interventional management of pulmonary arteriovenous malformations. EuroIntervention 12(Suppl X):X24–X27CrossRef
42.
go back to reference Papagiannis J, Apostolopoulou S, Sarris G, Rammos S (2002) Diagnosis and management of pulmonary arteriovenous malformations. Images Paediatr Cardiol 4:33–49PubMedPubMedCentral Papagiannis J, Apostolopoulou S, Sarris G, Rammos S (2002) Diagnosis and management of pulmonary arteriovenous malformations. Images Paediatr Cardiol 4:33–49PubMedPubMedCentral
43.
go back to reference Meek ME, Meek JC, Beheshti MV (2011) Management of pulmonary arteriovenous malformations. Semin Intervent Radiol 28:24–31CrossRef Meek ME, Meek JC, Beheshti MV (2011) Management of pulmonary arteriovenous malformations. Semin Intervent Radiol 28:24–31CrossRef
44.
go back to reference Krishnan AS, Babar JL, Gopalan D (2012) Imaging of congenital and acquired disorders of the pulmonary artery. Curr Probl Diagn Radiol 41:165–178CrossRef Krishnan AS, Babar JL, Gopalan D (2012) Imaging of congenital and acquired disorders of the pulmonary artery. Curr Probl Diagn Radiol 41:165–178CrossRef
45.
go back to reference Berrocal T, Madrid C, Novo S, Gutiérrez J, Arjonilla A, Gómez-León N (2004) Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology. Radiographics 24:e17CrossRef Berrocal T, Madrid C, Novo S, Gutiérrez J, Arjonilla A, Gómez-León N (2004) Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology. Radiographics 24:e17CrossRef
46.
go back to reference Corbett HJ, Humphrey GM (2004) Pulmonary sequestration. Paediatr Respir Rev 5:59–68CrossRef Corbett HJ, Humphrey GM (2004) Pulmonary sequestration. Paediatr Respir Rev 5:59–68CrossRef
47.
go back to reference Freedom RM, Yoo SJ, Goo HW, Mikailian H, Anderson RH (2006) The bronchopulmonary foregut malformation complex. Cardiol Young 16:229–251CrossRef Freedom RM, Yoo SJ, Goo HW, Mikailian H, Anderson RH (2006) The bronchopulmonary foregut malformation complex. Cardiol Young 16:229–251CrossRef
48.
go back to reference Akgun V, Battal B, Sari S (2014) Bronchial arteries: normal anatomy, variation and radiologic evaluation. Surg Radiol Anat 36:103–104CrossRef Akgun V, Battal B, Sari S (2014) Bronchial arteries: normal anatomy, variation and radiologic evaluation. Surg Radiol Anat 36:103–104CrossRef
49.
go back to reference Yener Ö, Türkvatan A, Yüce G, Yener AÜ (2015) The normal anatomy and variations of the bronchial arteries: evaluation with multidetector computed tomography. Can Assoc Radiol J 66:44–52 Yener Ö, Türkvatan A, Yüce G, Yener AÜ (2015) The normal anatomy and variations of the bronchial arteries: evaluation with multidetector computed tomography. Can Assoc Radiol J 66:44–52
50.
go back to reference Ley S, Kreitner KF, Morgenstern I, Thelen M, Kauczor HU (2002) Bronchopulmonary shunts in patients with chronic thromboembolic pulmonary hypertension: evaluation with helical CT and MR imaging. AJR Am J Roentgenol 179:1209–1215CrossRef Ley S, Kreitner KF, Morgenstern I, Thelen M, Kauczor HU (2002) Bronchopulmonary shunts in patients with chronic thromboembolic pulmonary hypertension: evaluation with helical CT and MR imaging. AJR Am J Roentgenol 179:1209–1215CrossRef
51.
go back to reference Bruzzi JF, Rémy-Jardin M, Delhaye D, Teisseire A, Khalil C, Rémy J (2006) Multi-detector row CT of hemoptysis. Radiographics 26:3–22CrossRef Bruzzi JF, Rémy-Jardin M, Delhaye D, Teisseire A, Khalil C, Rémy J (2006) Multi-detector row CT of hemoptysis. Radiographics 26:3–22CrossRef
52.
go back to reference Rémy-Jardin M, Duhamel A, Deken V, Bouaziz N, Dumont P, Remy J (2005) Systemic collateral supply in patients with chronic thromboembolic and primary pulmonary hypertension: assessment with multi-detector row helical CT angiography. Radiology 235:274–281CrossRef Rémy-Jardin M, Duhamel A, Deken V, Bouaziz N, Dumont P, Remy J (2005) Systemic collateral supply in patients with chronic thromboembolic and primary pulmonary hypertension: assessment with multi-detector row helical CT angiography. Radiology 235:274–281CrossRef
53.
go back to reference Nugent Z, Oliveira V, Maclusky I, Amaral J, Connolly B, Yang CL (2013) Bronchial artery-pulmonary artery malformation as a cause of cryptogenic hemoptysis. Pediatr Pulmonol 48:930–933CrossRef Nugent Z, Oliveira V, Maclusky I, Amaral J, Connolly B, Yang CL (2013) Bronchial artery-pulmonary artery malformation as a cause of cryptogenic hemoptysis. Pediatr Pulmonol 48:930–933CrossRef
54.
go back to reference Yon JR, Ravenel JG (2010) Congenital bronchial artery-pulmonary artery fistula in an adult. J Comput Assist Tomogr 34:418–420CrossRef Yon JR, Ravenel JG (2010) Congenital bronchial artery-pulmonary artery fistula in an adult. J Comput Assist Tomogr 34:418–420CrossRef
55.
go back to reference Yoon W, Kim JK, Kim YH, Chung TW, Kang HK (2002) Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review. Radiographics 22:1395–1409CrossRef Yoon W, Kim JK, Kim YH, Chung TW, Kang HK (2002) Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review. Radiographics 22:1395–1409CrossRef
56.
go back to reference Khalil A, Fartoukh M, Parrot A, Bazelly B, Marsault C, Carette MF (2010) Impact of MDCT angiography on the management of patients with hemoptysis. AJR Am J Roentgenol 195:772–778CrossRef Khalil A, Fartoukh M, Parrot A, Bazelly B, Marsault C, Carette MF (2010) Impact of MDCT angiography on the management of patients with hemoptysis. AJR Am J Roentgenol 195:772–778CrossRef
Metadata
Title
Pictorial review of the pulmonary vasculature: from arteries to veins
Authors
Thomas J. Marini
Kevin He
Susan K. Hobbs
Katherine Kaproth-Joslin
Publication date
01-12-2018
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 6/2018
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1007/s13244-018-0659-5

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