A Case of Pulmonary Varix Associated with Superior Pulmonary Vein Occlusion

Abstract

A pulmonary varix is a localized dilatation of a pulmonary vein, which is usually asymptomatic presented as a mass on a chest roentgenogram, and diagnosed with pulmonary angiography. We encountered a case of 55 year-old man, in whom incidentally identified was a dilated blood vessel that passed through the minor fissure and returned to the inferior pulmonary vein, which we diagnosed as pulmonary varix. This vascular anomaly was accompanied by the occluded superior pulmonary vein, highly suggestive of the developmental mechanism of this disease.

Pulmonary varix clearly demonstrated by 3D-CT before pulmonary angiography

“…With less frequency, the symptoms reported include cough, dyspnea, palpitations, chest oppression, orthopnea, hemoptysis, and cerebral infarction [7] . Middle lobe syndrome due to hemoptysis, compression of the bronchus, and swallowing disorder due to esophageal compression have been reported [ 4 , 8 ]. Death caused by rupture or thrombosis has also been reported [1] .…”

Pulmonary venous varix associated with mitral regurgitation mimicking a mediastinal mass: A case report and review of the literature

“…Complications of PVV include hemoptysis due to rupture, or bronchial compression resulting in middle lobe syndrome, esophageal compression inducing dysphagia, and cerebral infarction due to thromboembolic sequelae [4] , [8] , [19] . In most of the cases, the treatment of an asymptomatic PVV is unnecessary.…”

“…However, monitoring is crucial. The increase in size increases the risk of complication and the necessity to undergo surgical intervention [7] , [19] . Symptomatic patients with pulmonary venous hypertension due to mitral valve disease must undergo mitral valve replacement surgery, especially if the varix has progressively increased in size [6] .…”

March 2019 pulmonary case of the month: A 59-year-old woman with fatigue

“…Bechet's disease, causes pulmonary arterial aneurysms (2). Pulmonary varices are rare with only 71 cases reported prior to 1988 (3,4). The varices can be divided into congenital and acquired type cases.…”

“…No treatment is generally necessary for pulmonary varices (3,4). Very rarely complications such as recurrent infection, rupture with hemorrhage/hemoptysis, or cerebral emboli have resulted which may necessitate intervention.…”