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Fernandes CJCDS, de Oliveira EP, Salibe-Filho W, Terra-Filho M, Jardim CVP, Kato-Morinaga LT, Hoette S, de Souza R. Lung Cavities in Chronic Thromboembolic Pulmonary Hypertension. Clinics (Sao Paulo) 2020; 75:e1373. [PMID: 31939560 PMCID: PMC6945287 DOI: 10.6061/clinics/2020/e1373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/17/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Chronic thromboembolic pulmonary hypertension (CTEPH) is a unique form of pulmonary hypertension (PH) that arises from obstruction of the pulmonary vessels by recanalized thromboembolic material. CTEPH has a wide range of radiologic presentations. Commonly, it presents as main pulmonary artery enlargement, peripheral vascular obstructions, bronchial artery dilations, and mosaic attenuation patterns. Nevertheless, other uncommon presentations have been described, such as lung cavities. These lesions may be solely related to chronic lung parenchyma ischemia but may also be a consequence of concomitant chronic infectious conditions. The objective of this study was to evaluate the different etiologies that cause lung cavities in CTEPH patients. METHODS A retrospective data analysis of the medical records of CTEPH patients in a single reference PH center that contained or mentioned lung cavities was conducted between 2013 and 2016. RESULTS Seven CTEPH patients with lung cavities were identified. The cavities had different sizes, locations, and wall thicknesses. In two patients, the cavities were attributed to pulmonary infarction; in 5 patients, an infectious etiology was identified. CONCLUSION Despite the possibility of being solely associated with chronic lung parenchyma ischemia, most cases of lung cavities in CTEPH patients were associated with chronic granulomatous diseases, reinforcing the need for active investigation of infectious agents in this setting.
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Affiliation(s)
- Caio Julio Cesar dos Santos Fernandes
- Unidade de Hipertensao Pulmonar, Departamento de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto do Cancer do Estado de São Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Sirio Libanes, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Ellen Pierre de Oliveira
- Unidade de Hipertensao Pulmonar, Departamento de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Willian Salibe-Filho
- Unidade de Hipertensao Pulmonar, Departamento de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Mario Terra-Filho
- Unidade de Hipertensao Pulmonar, Departamento de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Sirio Libanes, Sao Paulo, SP, BR
| | - Carlos Vianna Poyares Jardim
- Unidade de Hipertensao Pulmonar, Departamento de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Sirio Libanes, Sao Paulo, SP, BR
| | - Luciana Tamie Kato-Morinaga
- Unidade de Hipertensao Pulmonar, Departamento de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Sirio Libanes, Sao Paulo, SP, BR
| | - Susana Hoette
- Unidade de Hipertensao Pulmonar, Departamento de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rogerio de Souza
- Unidade de Hipertensao Pulmonar, Departamento de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Sirio Libanes, Sao Paulo, SP, BR
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Kasai H, Sugiura T, Kobayashi T, Okamura R, Oota M, Harada N, Wada Y, Oota S, Yoshino I, Nakatani Y, Tatsumi K. Recurrence of Pulmonary Arteriovenous Malformation with Non-tuberculous Mycobacteria Infection Caused by Perfusion from the Pulmonary Artery and Bronchial Artery after Coil Embolization. Intern Med 2019; 58:1593-1596. [PMID: 30713314 PMCID: PMC6599918 DOI: 10.2169/internalmedicine.1969-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Recurrence of an embolized pulmonary arteriovenous malformation (PAVM) is common after coil embolization. A 23-year-old woman who had undergone multiple instances of transcatheter coil embolization was admitted with hypoxia and hemoptysis. A PAVM in the left S6 was found to be recanalized by reperfusion through the pulmonary and bronchial arteries. The left S6 was partially resected; the specimen contained necrotic granulomas and non-tuberculous mycobacteria (NTM) around the PAVM. Clinicians should consider possible recurrence of PAVM after reperfusion of the pulmonary and bronchial arteries, as well as the risk of NTM infection during follow-up of patients who have undergone repeated coil embolization.
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Affiliation(s)
- Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
- Health Professional Development Center, Chiba University Hospital, Japan
- Department of Medicine, School of Medicine, Chiba University, Japan
| | - Toshihiko Sugiura
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Takayuki Kobayashi
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Risa Okamura
- Department of Medicine, School of Medicine, Chiba University, Japan
| | - Masayuki Oota
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Japan
| | - Nao Harada
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Japan
| | - Yoshinobu Wada
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Satoshi Oota
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Yukio Nakatani
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Japan
| | - Koichiro Tatsumi
- Health Professional Development Center, Chiba University Hospital, Japan
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