ABSTRACT
Unilateral pulmonary artery hypoplasia (UPAH) is a rare disease in adults and is frequently accompanied by a congenital cardiac anomaly at a young age. The diagnosis is usually based on computed tomography (CT), angiography, and magnetic resonance imaging (MRI). However, no reports are available on retrograde flow in patients with UPAH. We describe a 68-year-old man with isolated UPAH and retrograde blood flow. He was admitted for dyspnea on exertion for the past 23 years. His diagnosis was delayed, as his symptoms and signs mimicked his underlying pulmonary diseases, such as emphysema and previous tuberculous pleurisy sequelae. A discrepancy was detected between the results of a ventilation-perfusion scan and the CT image. This was resolved by MRI, which showed retrograde blood flow from the right to the left pulmonary artery. Using MRI, we diagnosed this patient with isolated pulmonary artery hypoplasia and retrograde flow.
Subject(s)
Adult , Aged , Humans , Angiography , Dyspnea , Emphysema , Lung Diseases , Magnetic Resonance Imaging , Pulmonary Artery , Rare Diseases , Regional Blood Flow , Tuberculosis, PleuralABSTRACT
Pulmonary actinomycosis is an indolent and slowly progressive infectious disease, accompanied by pleural effusion and empyema in about 50% of cases. The size of the effusion is usually small, though, and it responds to appropriate antibiotics. We report a case of rapidly progressing, severe empyema leading to respiratory failure that was caused by pulmonary actinomycosis. A 57-year-old man presented with pleuritic chest pain for 5 days. The initial plain chest radiograph and CT scan showed pleural effusion. Gross pus was observed during the thoracentesis and laboratory test of pleural effusion revealed empyema. In spite of empirical antibiotics and chest tube drainage, the empyema rapidly progressed and the patient reached respiratory failure. Mechanical ventilation applied and decortication via video-assisted thoracotomy was performed. Microscopic examination of both the pleural and adjacent lung biopsy specimen revealed actinomycosis.
