AB 65. Rare case of hemoptysis due to pulmonary vascular malformation

Background: Presentation of a case report of hemoptysis in a 24-year-old patient with vascular dysplasia on the background of inferior vena cava aplasia.

Patients and methods: A 24-year-old male patient, with BMI 40, was admitted to our department for the investigation of bloody sputum occurring 2-3 times a week for the last trimester. Course of illness: the clinical examination of the patient showed a widening of the superficial vascular network in abdominal area. The ORL examination showed no focus of bleeding from the upper respiratory system. The patient did not receive any antiplatelet or anticoagulation treatment. Angio-CT of pulmonary artery showed a lesion in the anterior basal segment of the right lower lobe, also an extensive dilated azygos vein. Liver ECHO showed normal organ size and no points of portal hypertension. Inferior vena cava was not depicted under mesogastrium. The absence of inferior vena cava was investigated with abdominal CT which showed aplasia of the inferior vena cava with adjacent vein system development (widening of azygos and lower epigastric veins). Heart ECHO showed normal findings. HRCT showed a lesion on the right lower lobe with ground glass peripheral lesions. The pulmonary vein angiography was not revealing, bronchoscopy showed no pathological findings and gastroscopy-colonoscopy were also normal.

Results: The findings of inferior vena cava aplasia and widening of azygos system combined with the formation of the right lower lobe raised suspicion that the hemoptysis was due to certain vascular malformation. In collaboration with the radiologists an angio-CT of the pulmonary artery was performed, which revealed a lesion that could de attributed to vascular malformation in the right lower lobe. The lesion was surgically removed in 15/7/2011. The histology report showed a vascular malformation of the lung without evidence of lung malignancy.

Conclusions: The patient had a good postoperative course with no complications or a new incident of hemoptysis.