[Bronchial stenosis of vascular origin in pulmonary arterial hypertension].
A case is reported of bronchial stenosis due to a vascular cause in a patient with chronic obstructive lung disease, cor pulmonale and pulmonary arterial hypertension. This led to right lower lobe atelectasis and acute respiratory failure (pHa 7.24; PaCO2 85 mmHg; PaO2 44 mmHg) with important right-to-left shunting. This diagnosis was only suggested on day 7 by fibreoptic bronchoscopy and confirmed a week later by tomography and digital angiography. Nifedipine, used to reduce the pulmonary arterial hypertension, increased the cardiac index (31.min-1.m-2 to 3.3.1.min-1.m-2) and oxygen transport (488 ml.min-1.m-2 to 554 ml.min-1.m-2), despite increasing the shunt effect (Qs/QT: 26% to 31%). This and the antiinflammatory action of methylprednisolone were probably responsible for the favourable outcome.
D000368:Aged; D001982:Bronchial Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology*; D001999:Bronchoscopy; D003251:Constriction, Pathologic; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D008173:Lung Diseases, Obstructive / Q000150:complications*; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011660:Pulmonary Heart Disease / Q000150:complications*; D011859:Radiography; D012131:Respiratory Insufficiency / Q000209:etiology; D013382:Subtraction Technique
Sténose bronchique d'origine vasculaire en cours d'hypertension artérielle pulmonaire.