RESUMO
ABSTRACT: A 58-year-old man with resected liposarcoma exhibited persistent irregular interlobular septal thickening of lung on CT concerning lymphangitic metastasis. FDG PET/CT was positive in these foci. There was a narrowing of the pulmonary veins, which had not been seen on the imaging conducted prior to radiofrequency ablation therapy for atrial fibrillation. Lung perfusion scanning demonstrated more extensive hypoperfusion. This case highlights the diagnostic pitfalls of interstitial thickening of the lung in cancer patients. Meticulous history review and nuclear imaging helped distinguish the postablation pulmonary venous stenosis from metastatic spread to the lung interstitium.
Assuntos
Lipossarcoma , Estenose de Veia Pulmonar , Humanos , Masculino , Pessoa de Meia-Idade , Lipossarcoma/diagnóstico por imagem , Diagnóstico Diferencial , Estenose de Veia Pulmonar/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Ablação por Radiofrequência , Veias Pulmonares/diagnóstico por imagemRESUMO
This case centers on a 76-year-old male experiencing exertional dyspnea and hemoptysis, with a medical history marked by recurrent pulmonary embolism and chronic obstructive pulmonary disease (COPD). Notably, he resides in a histoplasmosis-endemic area. A computed tomography (CT) pulmonary embolism scan revealed notable findings, including an enlarged right lower pulmonary artery, vascular congestion, atelectasis, and a mass exerting pressure on the right lower pulmonary vein. Biopsy results identified the mass as fibrosing mediastinitis, likely attributed to histoplasmosis. A transthoracic echocardiogram indicated right ventricular dilatation, impaired function, and a right ventricular systolic pressure of 63 mm Hg. During right heart catheterization, the patient displayed disparate pulmonary artery wedge pressures (PAWPs) between the right and left sides. This discrepancy was linked to a blunted back wave from the left atrium to the catheter, induced by pulmonary vein compression. Although an infrequent phenomenon, the recorded asymmetry in PAWPs played a crucial role in guiding accurate patient management. The absence of subsequent evaluation of PAWP on the left side could have altered the treatment plan, potentially delaying appropriate patient care. This case emphasizes the necessity of thorough exploration with right heart catheterization when clinical symptoms warrant, highlighting the importance of standardized practices in such procedures.
Assuntos
Histoplasmose , Mediastinite , Embolia Pulmonar , Esclerose , Estenose de Veia Pulmonar , Idoso , Humanos , Masculino , Fibrose , Histoplasmose/complicações , Mediastinite/complicações , Mediastinite/diagnóstico , Embolia Pulmonar/complicações , Estenose de Veia Pulmonar/diagnóstico , Estenose de Veia Pulmonar/diagnóstico por imagem , West VirginiaAssuntos
Angioscopia , Fibrilação Atrial , Ablação por Cateter , Imagem Multimodal , Ultrassonografia de Intervenção , Humanos , Pessoa de Meia-Idade , Angioscopia/métodos , Fibrilação Atrial/cirurgia , Fibrilação Atrial/diagnóstico por imagem , Ablação por Cateter/efeitos adversos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Estenose de Veia Pulmonar/diagnóstico por imagem , Estenose de Veia Pulmonar/etiologiaRESUMO
Abstract Infantile scimitar syndrome (SS) is a rare congenital heart disease and has high mortality. Guidelines have not been established, but surgery is indicated in symptomatic patients. Despite the various surgical approaches, outcomes continue to be disappointing. We present our surgical experience with an infantile SS patient who had stenotic pulmonary veins contralateral to the hypoplastic lung with complicated anatomy. There are few cases with this complex pathology in the literature. Moreover, our patient was the first transplant-free survivor with this complexity in the literature.