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Successful treatment of massive haemoptysis in a young woman with anastomosis of right internal mammary artery to right superior pulmonary vein fistula
  1. Thor Bechsgaard1,
  2. Annette Midtgaard1,
  3. Erik Jakobsen2 and
  4. Anette Drøhse Kjeldsen3
  1. 1Radiology, Odense University Hospital, Odense, Denmark
  2. 2Cardiac, Thoracic, and Vascular Surgery, Odense University Hospital, Odense, Denmark
  3. 3ENT, Odense University Hospital, Odense, Denmark
  1. Correspondence to Thor Bechsgaard; thorbechsgaard{at}gmail.com

Abstract

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.

  • interventional radiology
  • cardiothoracic surgery

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Footnotes

  • Contributors TB wrote the manuscript with support from AM, EJ and ADK. Additionally, TB performed proofreading and approved of the final version before submission. AM evaluated and treated the patient with endovascular techniques, acquired relevant imaging data for the publication, and contributed with important insights regarding the disease entity in the drafting process as well as approved the final version before submission. EJ performed surgery to the patient, contributed with important insights regarding the disease entity in the drafting process as well as approved the final version before submission. ADK devised the project in cooperation with TB, AM and EJ and performed proofreading and approved the final version before submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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