The aberrant systemic-pulmonary artery communication: three-dimensional image simulation
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(2019) 14:35
CASE REPORT
Open Access
The aberrant systemic-pulmonary artery communication: three-dimensional image simulation Chun-Lin Kuo1, Kuan-Hsun Lin2, Kai-Hsiung Ko3 and Tsai-Wang Huang2*
Abstract Background: Congenital arterial abnormalities are unusual causes of hemoptysis in elder patients. Appropriate image examination and recognition of the variant vessels are crucial in achieving precise diagnosis and successful treatment. Case presentation: We report a case of 70-year-old female presenting with hemoptysis. Computed tomography angiography showed hypervascular lesions in the lingula of the left lung abutting the pericardium. Threedimensional reconstruction image revealed an aberrant systemic arterial supply communicating with the left pulmonary artery and co-supplying the pulmonary parenchyma of the left upper. Single-port video-assisted thoracoscopic surgery with anomalous vessel ligation and lingual segmentectomy were performed smoothly. The symptom of hemoptysis subsided after operation with 2-year follow up. Conclusion: An anomalous systemic arterial supply to the left upper lobe of the lung with an aberrant systemic system draining into the left pulmonary artery and co-supplying the lung parenchyma is extremely rare. Preoperative simulation with three-dimensional reconstruction image provides a clear spatial anatomy that allows clinicians to identify the orientation of the vessels more precisely when deciding on intervention. Keywords: Hemoptysis, Anomalous arterial supply, 3-D image simulation
Background Hemoptysis is one of the common symptoms in clinical practice. Besides the common causes of hemoptysis such as bronchiectasis, infections or malignancies, congenital vascular abnormalities are also potential differential diagnoses that are prone to be neglected [1]. Here we report an extremely rare case of a 70-year-old woman with an anomalous systemic artery draining into the pulmonary artery and co-supplying the left upper lobe of the lung. As three-dimensional (3-D) reconstruction image has gradually replaced the diagnostic role of angiography in the aspect of determination of anomalous vessels [2], we present this rare congenital scenario and emphasize the importance of 3-D reconstruction image in providing not only a diagnosis but also preoperative simulation. * Correspondence: [email protected] 2 Department of Surgery, Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Kung Road, Taipei 114, Taiwan, Republic of China Full list of author information is available at the end of the article
Case presentation The patient was a 70-year-old woman referred to our hospital because of four episodes of hemoptysis within one month. A history of myoma and pulmonary tuberculosis was noted before this admission. After admission, we arranged a series of examinations. No obviously abnormal findings were noted in the patient’s blood tests or sputum culture. Chest radiography revealed opacity of the left upper lung field (Fig. 1a). Chest
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