Brassil Michael, Li Yangmei, Ko Michael, Faughnan Marie E, Prabhudesai Vikramaditya
Department of Medical Imaging, St Michael's Hospital, Unity Health Toronto, Toronto, Canada.
Department of Thoracic Surgery, St Joseph's Health Center, Unity Health Toronto, Toronto, Canada.
BJR Case Rep. 2023 Sep 11;9(5):20230056. doi: 10.1259/bjrcr.20230056. eCollection 2023 Oct.
A 38-year-old male patient presenting with mild exertional dyspnea was noted to have a lingular opacity on chest radiograph. CT of the chest demonstrated an unusual complex inferior lingular vascular malformation with branches arising from the left internal thoracic artery and the left inferior diaphragmatic artery via the celiac artery. There was suspected communication with both pulmonary arterial and venous branches. Following thorough assessment and comprehensive clinical investigation, the patient elected to proceed to definitive surgical management due to potential risk of life-threatening hemoptysis. Interventional radiology performed pre-operative diagnostic angiography and embolization of the systemic feeding arteries. The patient proceeded to have an uncomplicated video-assisted thoracoscopic surgery segmentectomy and was discharged the next day. The patient was asymptomatic at follow-up with complete resolution of the malformation on CT at 6 months. We discuss an uncommon pathology which benefited from multidisciplinary management including successful pre-operative endovascular embolization.
一名38岁男性患者，表现为轻度劳力性呼吸困难，胸部X线片显示舌叶有模糊影。胸部CT显示舌叶下部有一个不寻常的复杂血管畸形，分支起源于左胸廓内动脉和经腹腔干的左下膈动脉。怀疑与肺动脉和静脉分支均有交通。经过全面评估和综合临床检查，由于存在危及生命的咯血潜在风险，患者选择进行确定性手术治疗。介入放射科进行了术前诊断性血管造影并栓塞了体循环供血动脉。患者顺利接受了无并发症的电视辅助胸腔镜手术节段切除术，并于次日出院。随访时患者无症状，6个月时CT显示畸形完全消失。我们讨论了一种罕见的病理情况，其受益于多学科管理，包括成功的术前血管内栓塞。
