AN UNREPORTED FINDING OF LUNG VENOUS MALFORMATION IN A PATIENT WITH HEMOPTYSIS

Abstract

TYPE: Late Breaking Case Report TOPIC: Pulmonary Vascular Disease INTRODUCTION: Pulmonary anomalous venous drainage is classified as total anomalous pulmonary venous connection and partial anomalous pulmonary venous connection. We present an unreported case of upper pulmonary segments anomalous venous drainage and hemoptysis. CASE PRESENTATION: A 66-year-old female with a medical history of brain aneurysms, breast cancer, and hypertension presented with hemoptysis. The patient had an angiogram in 2017 that revealed a low flow vascular malformation in the left upper lobe without an identifiable arterial feeder, amenable to embolization. CTA of the chest did not have an active bleed. The patient underwent another pulmonary arteriogram which showed anomalous venous drainage through large tortuous varix seen from anterior, apical-posterior, and inferior segmental arteries. DISCUSSION: This is a previously unreported finding of apical-posterior lung segments with venous drainage inferior and posterior to a tortuous vein distally becoming the left upper pulmonary vein. This finding was only visible in the late venous phase. An accessory vein was also appreciated. The relationship to hemoptysis might be associated with elevated arterial pulmonary hypertension in the draining segments of the lung. However, the mechanism is unknown. Although this was the second episode, we decided not to perform further interventions since the patient remained hemodynamically stable and hemoptysis resolved. The long-term clinical significance of this finding in the setting of hemoptysis is not known. CONCLUSIONS: This finding of vascular malformation presenting with hemoptysis has unknown pathophysiology. Current management is conservative due to the soft limiting nature of her symptoms and no previous documentation of similar findings. DISCLOSURE: Nothing to declare. KEYWORD: vascular malformation