Toupchiani Saeideh, Hegab Shady, Rana Dur-E-Sameen, Ainley Adam
Department of Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK.
Department of Radiology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK.
Radiol Case Rep. 2023 Mar 12;18(5):1905-1908. doi: 10.1016/j.radcr.2023.02.029. eCollection 2023 May.
We report the case of a middle-aged woman on a background of severe respiratory disease who presented with hemoptysis. Investigations with CT pulmonary angiogram showed evidence of a large pulmonary arterial filling defect which was initially treated as a pulmonary embolism. However, despite being anticoagulated, she experienced ongoing hemoptysis. Further imaging several days later using aortic phase CT confirmed that the filling defect was a false positive; the artifact was due to retrograde filling from a systemic arterial-pulmonary arterial shunt and anticoagulation was stopped. Although PE is the most common cause of filling defects, this case suggests that in the setting of patients with chronic inflammatory parenchymal pulmonary disease, clinicians should consider alternative causes such as systemic arterial-pulmonary arterial shunts.
我们报告了一例患有严重呼吸道疾病的中年女性，她出现了咯血症状。胸部CT肺动脉造影检查显示有一个大的肺动脉充盈缺损，最初被当作肺栓塞进行治疗。然而，尽管进行了抗凝治疗，她仍持续咯血。几天后使用主动脉期CT进行的进一步成像证实该充盈缺损是假阳性；该伪像是由于体动脉-肺动脉分流的逆行充盈所致，于是停止了抗凝治疗。虽然肺栓塞是充盈缺损最常见的原因，但该病例表明，对于患有慢性炎症性实质性肺病的患者，临床医生应考虑诸如体动脉-肺动脉分流等其他原因。
