title: Multimodality Imaging Diagnostic Approach of Systemic-to-Pulmonary Vein Fistulae.
abstract: A 26-year-old man with a history of bilateral lung transplantation for pulmonary cystic fibrosis 6 months before was admitted in our institution for acute heart failure. Cardiac magnetic resonance imaging (CMR) showed an increased aortic output, as aortic flow assessed by velocity mapping was twofold the pulmonary flow, an occluded superior vena cava (SVC), and enlarged azygos vein. A systemic-to-pulmonary vein fistula (SAPVF) was suspected. The selective angiography showed numerous fistulae between intercostals, thyro-cervical, internal mammary arteries and pulmonary veins. The thoracic CT performed before the CMR, which was initially considered as normal, showed well these arteriovenous fistulae after 3D MIP reconstruction. This particular observation highlights the great value of multimodality imaging for the diagnosis of this rare pathology. The MR velocity mapping is a noninvasive imaging technique of great interest to guide the diagnosis of arteriovenous fistulae, and further indicating more invasive complementary imaging modalities like selective arterial angiography.
authors.affiliation: Department of Radiology, University Hospital of Strasbourg, Strasbourg, France.|Department of Nuclear Medicine, University Hospital of Strasbourg, Strasbourg, France.|Faculty of Medicine, ICube, UMR 7357 University of Strasbourg/CNRS and FMTS, Strasbourg, France.
authors.forename: Soraya
authors.initials: S
authors.lastname: El Ghannudi
authors.affiliation: Department of Radiology, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Germain
authors.affiliation: Department of Radiology, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Mi-Young
authors.initials: MY
authors.lastname: Jeung
authors.affiliation: Department of Radiology, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Jahn
authors.affiliation: Department of Pneumology, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Hirschi
authors.affiliation: Department of Radiology, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Roy
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D004452:Echocardiography / Q000379:methods; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000601:surgery; D013902:Radiography, Thoracic / Q000379:methods; D016896:Treatment Outcome
keywords: cardiac magnetic resonance imaging; diagnostic imaging tools; pulmonary arteriovenous fistulae; shunt