A Case of Pulmonary Hypertension Due to Fistulas Between Multiple Systemic Arteries and the Right Pulmonary Artery in an Adult Discovered for Occulted Dyspnoea.
BACKGROUND
Pulmonary hypertension (PH) can be caused by a fistula between the systemic and pulmonary arteries. Here, we report a case of PH due to multiple fistulas between systemic arteries and the right pulmonary artery where the ventilation/perfusion scan showed no perfusion in the right lung.


METHODS
A 32-year-old male patient was hospitalised for community-acquired pneumonia. After treatment with antibiotics, the pneumonia was alleviated but dyspnoea persisted. Pulmonary hypertension was diagnosed using right heart catheterisation, which detected the mean pulmonary artery pressure as 37mmHg. The anomalies were confirmed by contrast-enhanced CT scan (CT pulmonary angiography), systemic arterial angiography and pulmonary angiography.


RESULTS
Following embolisation of the largest fistula, the haemodynamics and oxygen dynamics did not improve, and even worsened to some extent. After supportive therapy including diuretics and oxygen, the patient's dyspnoea, WHO function class and right heart function by transthoracic echocardiography all improved during follow-up.


CONCLUSIONS
Pulmonary hypertension can be present even when the right lung perfusion is lost. Closure of fistulas by embolisation, when those fistulas act as the proliferating vessels, may be harmful.
Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders. Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Institute of Respiratory Medicine, Beijing, P.R. China, 100020; Department of Respiratory Disease, Capital Medical University, Beijing, P.R. China, 100069. Electronic address: lijifengcyh@163.com.
Ji-Feng
JF
Li
Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders. Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Institute of Respiratory Medicine, Beijing, P.R. China, 100020; Department of Respiratory Disease, Capital Medical University, Beijing, P.R. China, 100069. Electronic address: zhaizhenguo2011@126.com.
Zhen-Guo
ZG
Zhai
Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders. Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Institute of Respiratory Medicine, Beijing, P.R. China, 100020; Department of Respiratory Disease, Capital Medical University, Beijing, P.R. China, 100069. Electronic address: ktg2004@sina.com.
Tu-Guang
TG
Kuang
Department of Image, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020. Electronic address: mikie0763@126.com.
Min
M
Liu
Department of Image, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020. Electronic address: mzhh1166@hotmail.com.
Zhan-Hong
ZH
Ma
Department of Echocardiography, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020. Electronic address: yidan_li@163.com.
Yi-Dan
YD
Li
Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders. Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China, 100020; Beijing Institute of Respiratory Medicine, Beijing, P.R. China, 100020; Department of Respiratory Disease, Capital Medical University, Beijing, P.R. China, 100069. Electronic address: yyh1031@sina.com.
Yuan-Hua
YH
Yang
D000328:Adult; D001159:Arterio-Arterial Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D000072226:Computed Tomography Angiography; D003287:Contrast Media / Q000008:administration & dosage; D004417:Dyspnea / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D004621:Embolization, Therapeutic; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D008297:Male; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*
D003287:Contrast Media
Diuretics; Dyspnoea; Embolisation; Fistula; Pulmonary hypertension