The
patient had a known central right lower lung bronchogenic carcinoma. He presented with
massive hemoptysis. The admission chest radiograph demonstrated dense consolidation and
volume loss within the right lower lung.
Bronchial
artery arteriogram demonstrated a bronchial artery to pulmonary artery fistula (arrow) and
bronchial artery embolization was performed.
Unfortunately, the patient's hemoptysis persisted, and the patient required right lung
pneumonectomy. At surgery, the tumor was found to be adherent to the pericardium, which
was partially resected, but not closed. Post operatively, the patient became clinically
unstable and hypotensive.
The
post-operative chest radiograph demonstrated complete shift of the cardiac silhouette into
the right hemithorax, however, the cardiac apex appeared to be on the right- a finding
which was suspicious for cardiac torsion.
A pleural tube was inserted into the right chest and air instilled to better outline the
heart- again- the findings were suspicious for cardiac torsion.
Finally,
a Swan-Ganz catheter was placed (arrow) and confirmed the cardiac torsion, which was
corrected surgically.
