A Case Report of Pulmonary Vein Stenosis Within the Labyrinth of Fibrosing Mediastinitis.
J Investig Med High Impact Case Rep
; 12: 23247096241244729, 2024.
Article
en En
| MEDLINE
| ID: mdl-38577759
ABSTRACT
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.
Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Embolia Pulmonar
/
Esclerosis
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Estenosis de Vena Pulmonar
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Histoplasmosis
/
Mediastinitis
Límite:
Aged
/
Humans
/
Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Investig Med High Impact Case Rep
Año:
2024
Tipo del documento:
Article
País de afiliación:
Estados Unidos