Successful treatment of massive haemoptysis in a young woman with anastomosis of right internal mammary artery to right superior pulmonary vein fistula

A 21-year-old, otherwise healthy, female patient was admitted with haemoptysis. Chest X-ray and CT found a consolidated right middle pulmonary lobe. Catheter angiography of ascending aorta visualised two hypertrophic and tortuous branches of the right internal mammary artery with a fistula to the ri...

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Published inBMJ case reports Vol. 14; no. 5; p. e240739
Main Authors Bechsgaard, Thor, Midtgaard, Annette, Jakobsen, Erik, Kjeldsen, Anette Drøhse
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 25.05.2021
BMJ Publishing Group
Subjects
Adult
Anastomosis, Surgical
Bronchoscopy
Case Report
Case reports
Catheters
Congenital diseases
Coronary vessels
Female
Fistula
Hemoglobin
Hemoptysis - etiology
Hemoptysis - therapy
Humans
Inflammation
Mammary Arteries - diagnostic imaging
Medical imaging
Mortality
Ostomy
Patients
Pulmonary arteries
Pulmonary Artery
Pulmonary Veins - diagnostic imaging
Pulmonary Veins - surgery
Thoracic surgery
Veins & arteries
Womens health
Young Adult
cardiothoracic surgery
interventional radiology
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Summary:A 21-year-old, otherwise healthy, female patient was admitted with haemoptysis. Chest X-ray and CT found a consolidated right middle pulmonary lobe. Catheter angiography of ascending aorta visualised two hypertrophic and tortuous branches of the right internal mammary artery with a fistula to the right superior pulmonary vein. The inflow was embolised with coils. Catheter angiography of descending aorta found hypertrophic right bronchial arteries and right phrenic artery supplying a web-like network of vessels, which drained to the right superior pulmonary vein with discrete filling of an accessory right middle pulmonary vein. CT angiography with a catheter for contrast administration in the ascending aorta was performed for characterisation. After two additional episodes of haemoptysis, right middle lobe lobectomy was performed. Perioperatively pulmonary artery blood supply to the right middle pulmonary lobe was absent and an atretic accessory middle pulmonary vein was seen. The patient was discharged 7 days afterwards without sequelae.
Bibliography:ObjectType-Case Study-2
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ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-240739