Ji-Feng Li1, Zhen-Guo Zhai2, Tu-Guang Kuang3, Min Liu4, Zhan-Hong Ma5, Yi-Dan Li6, Yuan-Hua Yang7. 1. Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders. Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Institute of Respiratory Medicine, Beijing, P.R. China, 100020; Department of Respiratory Disease, Capital Medical University, Beijing, P.R. China, 100069. Electronic address: lijifengcyh@163.com. 2. Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders. Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Institute of Respiratory Medicine, Beijing, P.R. China, 100020; Department of Respiratory Disease, Capital Medical University, Beijing, P.R. China, 100069. Electronic address: zhaizhenguo2011@126.com. 3. Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders. Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Institute of Respiratory Medicine, Beijing, P.R. China, 100020; Department of Respiratory Disease, Capital Medical University, Beijing, P.R. China, 100069. Electronic address: ktg2004@sina.com. 4. Department of Image, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020. Electronic address: mikie0763@126.com. 5. Department of Image, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020. Electronic address: mzhh1166@hotmail.com. 6. Department of Echocardiography, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020. Electronic address: yidan_li@163.com. 7. Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders. Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Institute of Respiratory Medicine, Beijing, P.R. China, 100020; Department of Respiratory Disease, Capital Medical University, Beijing, P.R. China, 100069. Electronic address: yyh1031@sina.com.
Abstract
BACKGROUND: Pulmonary hypertension (PH) can be caused by a fistula between the systemic and pulmonary arteries. Here, we report a case of PH due to multiple fistulas between systemic arteries and the right pulmonary artery where the ventilation/perfusion scan showed no perfusion in the right lung. METHODS: A 32-year-old male patient was hospitalised for community-acquired pneumonia. After treatment with antibiotics, the pneumonia was alleviated but dyspnoea persisted. Pulmonary hypertension was diagnosed using right heart catheterisation, which detected the mean pulmonary artery pressure as 37mmHg. The anomalies were confirmed by contrast-enhanced CT scan (CT pulmonary angiography), systemic arterial angiography and pulmonary angiography. RESULTS: Following embolisation of the largest fistula, the haemodynamics and oxygen dynamics did not improve, and even worsened to some extent. After supportive therapy including diuretics and oxygen, the patient's dyspnoea, WHO function class and right heart function by transthoracic echocardiography all improved during follow-up. CONCLUSIONS: Pulmonary hypertension can be present even when the right lung perfusion is lost. Closure of fistulas by embolisation, when those fistulas act as the proliferating vessels, may be harmful.
BACKGROUND:Pulmonary hypertension (PH) can be caused by a fistula between the systemic and pulmonary arteries. Here, we report a case of PH due to multiple fistulas between systemic arteries and the right pulmonary artery where the ventilation/perfusion scan showed no perfusion in the right lung. METHODS: A 32-year-old male patient was hospitalised for community-acquired pneumonia. After treatment with antibiotics, the pneumonia was alleviated but dyspnoea persisted. Pulmonary hypertension was diagnosed using right heart catheterisation, which detected the mean pulmonary artery pressure as 37mmHg. The anomalies were confirmed by contrast-enhanced CT scan (CT pulmonary angiography), systemic arterial angiography and pulmonary angiography. RESULTS: Following embolisation of the largest fistula, the haemodynamics and oxygen dynamics did not improve, and even worsened to some extent. After supportive therapy including diuretics and oxygen, the patient's dyspnoea, WHO function class and right heart function by transthoracic echocardiography all improved during follow-up. CONCLUSIONS:Pulmonary hypertension can be present even when the right lung perfusion is lost. Closure of fistulas by embolisation, when those fistulas act as the proliferating vessels, may be harmful.