A 21-year-old patient post double lung transplant for cystic fibrosis was found to have a right hilar mass compressing the right pulmonary veins and right lung nodules. Endobronchial ultrasound (EBUS) and computed tomographic (CT) guided lung biopsy of these lesions, both resulted in massive hemoptysis >200mls after the first needle pass. This case highlights the clinical and radiological features that should alert the interventionist to pulmonary hypertension to adequately prepare for biopsy-related bleeding complications.
The patient presented with fatigue, dyspnea and pyrexia on a background history of a double lung transplant for cystic fibrosis 1 year previously. Pre-transplant, the patient had chronic superior vena cava obstruction due to an implanted central venous line. Physical examination revealed anterior chest wall venous engorgement, upper extremity swelling and bibasal inspiratory crackles. CT of the chest demonstrated a 2.6 cm right hilar mass (Figure 1), which invaded and compressed the right superior and inferior pulmonary veins. Contrast-enhanced CT demonstrated interlobular septal thickening suggesting pulmonary venous hypertension and solid pulmonary nodules with ground glass halos, suggesting
An EBUS and a subsequent CT-guided biopsy were performed to make the critical distinction between suspected pulmonary and mediastinal aspergillus infection versus post-transplant lymphoproliferative disorder. EBUS transbronchial needle aspiration of the
Serum beta-D-glucan was strongly positive on two occasions and the patient improved with systemic antifungal therapy and subsequent oral posaconazole for
This case presentation highlights several important learning opportunities for the interventionist. Firstly, it illustrates the CT findings and relevance of pulmonary venous hypertension due to a mass compressing the pulmonary veins. CT demonstrated interlobular septal thickening and extrinsic compression of the right pulmonary veins. Secondly, the radiological and
Full conference title:
- ATS 2018