Exsanguinating hemoptysis revealing the absence of left pulmonary artery in an adult

Pneumonectomy for Unilateral Proximal Interruption of Pulmonary Artery: A Case Series from the Literature

BACKGROUND

Unilateral proximal interruption of the pulmonary artery (UPIPA) is a rare congenital disease, and its optimal management remains undefined in the existing literature. The occasional necessity for pneumonectomy is still supported by limited evidence.

METHODS

A systematic review of the literature was conducted using the PubMed search engine, focusing on UPIPA cases that received pneumonectomy. Thirty-one pertinent articles were selected and included in the analysis. A case reported from our institution was included in the analysis.

RESULTS

We found 25 adults and seven children affected by UPIPA who received an indication for pneumonectomy, plus an additional case that was reported by our institution. Among adult patients, the predominant indication was hemoptysis (57%), followed by suspected or confirmed lung cancer (23%). Approximately 46% of surgical procedures were classified as urgent or emergent. Postoperative complications were observed in 36% of cases, with no recorded mortality. In pediatric cases, pneumonectomy was primarily a life-saving intervention, performed urgently or emergently in 75% of instances. A possible late complication in pediatric patients involves a mediastinal shift leading to respiratory distress, which may be mitigated using an inflatable prosthesis.

CONCLUSIONS

Pneumonectomy achieves complete resolution of UPIPA symptoms. In the adult population, its primary indication is hemoptysis, with procedures conducted in both elective and urgent/emergent settings. Despite a mortality rate of zero, a notable proportion of patients may experience postoperative complications. In pediatric cases, the clinical presentation varies more extensively, and pneumonectomy is typically reserved for life-threatening situations, emphasizing the need for careful patient selection.

Unilateral pulmonary artery agenesis manifested by hemoptysis in pregnancy

Unilateral pulmonary artery agenesis (UPAA) is a rare congenital anomaly which can be symptomatic or even asymptomatic. Most of patients with isolated UPAA have mild symptoms and it is difficult to be diagnosed, especially when abnormal findings of chest radiograph are the first presentation. It is often misdiagnosed and is not considered during differential diagnosis. To make a diagnosis of UPAA, various imaging modalities including chest radiograph, computed tomography (CT), and angiography are used. We report a 33-year-old woman in pregnancy presented recurrent hemoptysis whose CT was postponed due to her pregnancy. Although CT is a useful diagnostic tool, chest radiograph could be used instead in pregnancy suggesting UPAA with a lot of information.

Pulmonary Artery Agenesis Associated With Emphysema and Multiple Invasive Non-Small Cell Lung Cancers

Pulmonary artery (PA) agenesis in the absence of associated cardiac abnormalities is a rare congenital abnormality. It may remain undiagnosed until adulthood when patients present with respiratory symptoms such as hemoptysis, dyspnea, repeated respiratory infections, or pulmonary hypertension. Herein we present a case of a 50-year-old woman who was found to have multiple, morphologically distinct non-small cell lung cancers in association with agenesis of the PA. This instance represents the fourth reported case of such association in the English literature.

[Non-tumoral vascular disorders of the lung in the adulthood]

Non-tumoral vascular disorders of the lung are multiple, even if cases diagnosed in the adulthood are rare. They include congenital or acquired conditions, which related symptoms, if present, are non specific. This explains why their diagnosis is challenging and usually delayed. Surgery is the cornerstone of their treatment, although interventional radiology represents currently a less invasive alternative option for some of them.

Unusual Case of Hemoptysis 13 Years After Bilobectomy

We describe a 68-year-old man with recurrent episodes of hemoptysis. The patient had undergone right upper and middle lobectomies for a benign cystic lesion 13 years ago and coronary artery bypass grafting for ischemic heart disease immediately before the onset of hemoptysis. Diagnostic work-up revealed that pulmonary arterial flow to the remaining right lower lobe had been inadvertently compromised by prior ligation of the right main pulmonary artery during the time of his bilobectomy, with the development of a robust collateral blood supply derived from bronchial and intercostals arteries. Successful treatment required percutaneous embolization of the dominant bronchial collaterals, followed by completion pneumonectomy.

Agénésie isolée de l'artère pulmonaire. À propos de huit observations

Unilateral primitive agenesia of pulmonary artery is a rare congenital disorder. Experience of three hospital-based pulmonology pediatric units including eight children (three boys and five girls) with such anomaly is reported (11 years median follow-up, range 6 months to 10 years). Median age at diagnosis was 4 years. Clinical features included recurrent respiratory tract infections (75%), effort dyspnea (50%) and, curiously, asthmatic symptoms (75%). Diagnosis was evoked on chest X rays and confirmed by angiography in all cases. Agenesis of the right pulmonary artery was more frequent (five cases). Abnormal vascular ring was associated in two cases of agenesis of the left pulmonary artery. Pulmonary function tests were performed in six children, with bronchial obstruction in two. Regular clinical follow-up, up to adult age in four cases, showed no complication, such as hemoptysis or pulmonary hypertension in our patients.

Long-term follow-up in a patient after pneumonectomy and SILASTIC prosthetic placement for unilateral pulmonary artery agenesis

Unilateral pulmonary artery agenesis is an exceedingly rare condition. The authors report the case of a 9-year-old girl with unilateral pulmonary artery agenesis who presented with exertional hemoptysis. The patient underwent a right pneumonectomy with placement of an expandable. SILASTIC(R) (Dow Corning, Midland, MI) prosthesis in the right thorax. A 13-year follow-up is reported, and management of this condition is discussed.