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Systemic artery to pulmonary artery fistula

Case contributed by Ilya Volovik
Diagnosis certain

Presentation

A patient with known lung carcinoid, came for a routine follow-up examination, without any new clinical complaints.

Patient Data

Age: 90 years
Gender: Female

An incidental finding, of an anomalous left-to-right shunting communication (fistula) between the ascending aorta and the right pulmonary artery.

The fistula is presented as a tortuous vessel (m/p 2 vessels) arising from the posterior part of the ascending aorta, with numerous "twists" around the trachea and esophagus, going down to the right pulmonary artery (supplying the right lower lobe) and isolated early enhancement of the right lower lobe pulmonary artery with contrast on arterial phase.

Other findings can be seen: Left lower lobe large lesion and a smaller lesion in right lower lobe - known carcinoid.

Case Discussion

This incidental finding was not obviously seen in previous studies, due to different scanning techniques, all previous studies were without contrast.

As for potential pulmonary hypertension secondary to right to left shunting, the patient did not have any complaints. The main pulmonary artery and the right pulmonary artery are both with normal diameter, without dilatation as a possible sign of pulmonary hypertension.

Unfortunately, the patient was lost to follow-up.

Courtesy of Dr. Yair Halpern.

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