Eur J Cardiothorac Surg 2004;25:282
© 2004 Elsevier Science NL
Images in cardio-thoracic surgery |
The rare case of pulmonary artery–right inferior pulmonary vein shunt
Arkadiusz A. Derkacza*,
Przemyslaw J. Nowickia,
Przemyslaw Jazwiecb,
Agnieszka Magott-Derkaczb
a Medical University, Cardiosurgery Department, Wroclaw, Poland
b Military Hospital, Department of Radiology, Wroclaw, Poland
Received 17 July 2003;
received in revised form 9 October 2003;
accepted 20 October 2003.
* Corresponding author. Cardiosurgery Department, Curie-Sklodowskiej 66 St., 50-369 Wroclaw, Poland. Tel.: +48-71-7840938; fax: +48-71-7840938
e-mail: aderkacz{at}chirs.am.wroc.pl
Key Words: Chest X-ray • Vascular malformation • Angio-CT • Heart catheterisation
A 47-year-old woman was admitted to hospital for the diagnostic evaluation of round opacity presented on the chest radiogram (Fig. 1
, upper part). She complained only of mild weakness. Chest angio-CT scan revealed a fistula originated from the pulmonary artery and drained into the right inferior pulmonary vein (Fig. 1). During heart catheterisation a small flow through the fistula was confirmed without evidence of oxygen saturation differences (Fig. 2
). The echocardiographic examination proved to show the correct dimensions of heart cavities. The patient was treated pharmacologically with diuretics. Sixteen months after hospitalisation the patient was doing well and had no cardiac symptoms.
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Fig. 1. RT-3D angioCT reconstruction. A fistula (arrow) between the branch of the right pulmonary artery (arrows) and the dilated right pulmonary vein with diameter of 21 mm (asterisks) is presented. A chest X-ray picture in the upper part of the figure shows a round consolidation (diameter about 15 mm) connected with the pulmonary hilus, which suggests a vascular malformation.
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Fig. 2. A selective contrast injection into the right branch of the pulmonary artery (part A) and delayed filling of abnormal pulmonary vein (part B). A fistula is not opacified, however, a small jet is visualised during injection. The opacity visible on the chest radiogram is pointed by a white arrow.
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