Copyright Article author (or theiremployer) 2013. Produced byBMJ Publishing Group Ltd (&BTS) under licence. 2 1 ocsKHK, Morcos cetd3 eebr2012 December 31 Accepted 2012 November 15 Revised 2012 October 14 Received [email protected] UK; 4DY, G81 Glasgow Clydebank, Street, Agamemnon Hospital, National Jubilee Golden Board, Centre Times Waiting National NHS Department, Cardiothoracic Morcos, Kamel Hani Karim to Correspondence UK Glasgow, In Royal Glasgow UK Glasgow, Clydebank, Hospital, National Jubilee Golden Board, Centre Times Waiting National NHS Department, ailg Department, Radiology Surgery Cardiothoracic 2012-202869 doi:10.1136/thoraxjnl- Year] [ First: Online Published S. Craig G, Roditi cite: To laeinclude please ocsKHK, Morcos OnlineFirst,publishedonJanuary24,2013as10.1136/thoraxjnl-2012-202869 tal et a Month Day fi . rmary, Thorax Thorax 2013; 0:1 eodr oploayvi obstruction pulmonary varices to tracheal secondary to due haemoptysis Life-threatening THORAX IN IMAGES en ntergtL,lf tim A irlannulus; mitral MA, ; . pulmonary left pulmonary enhancing LA, PA, no right are the there on and side compared left The hypoplastic the connections. is with and tree atrium arterial left pulmonary show right for to removed order level in annulus clarity mitral left to plus back bifurcation (LV) artery pulmonary to back trunk chambers, out right ventricular with right anterior from viewed vessels 1 Figure contrast con a scan CT and ECG-gated embolised. recurred enhanced was haemoptysis which However, right trunk prominent a and intercostobronchial artery pulmonary right small was and he and institution. our wor- reversed to was transferred Haemoptysis anticoagulation pulmonary so heparin. sened having with sus- anticoagulated of was increas- haemoptysis of frank pected history and day 3 breathlessness a ing with man 30-year-old A HISTORY Morcos, Kamel Hani Karim oe ih umnr en hthdno had that a veins atrium, left the pulmonary to throm- communication right showed and artery bosed pulmonary right plastic to hr eeanme fvnu oltrl to collaterals venous of number a native were discernable the there were as no ition drain had only could veins the pulmonary the were distal which which by veins and means bronchial by encircled main the right Intraoperatively, . right stapled perfusion lung. little right the very of but ventilation normal scan showed (V/Q) perfusion ventilation A varices. bronchial con 2). ( and smooth 1 airway with the walls into indentations bronchial mucosal thickened and hilum – .doi:10.1136/thoraxjnl-2012-202869 2. umnr n rnha nigah eelda revealed bronchial and Pulmonary h ain newn tnaddissectional standard a underwent patient The ouernee Tiaeo er n great and heart of image CT rendered Volume fl wtat(VT n pulmonary and (RVOT) tract ow fi mdcrnladright and carinal rmed 1 ie Roditi, Giles fi mdahypo- a rmed fl ‘ bulky w nadd- In ow. ’ fi gures right 2 twr Craig Stewart inwti h al ftearaswr tracheal were . airways venous the pulmonary by of caused walls varices thrombosis circula- the collateral venous within prominent tion pulmonary The unclear. the remains of aetiology ies a as asv haemoptysis. massive cause occlusive may venous disease pulmonary from varices Tracheal DISCUSSION arrow). (white pulmonary enhanced thrombosed not atretic are the veins on where none side but right tributaries the venous pulmonary left enhanced 2 Figure oayatr alcuigstenosis. causing wall artery in monary moderate chronic acquired dilated of an bron- a was degree hilar There and the submucosa. involving recanalisation chial plexus of venous signs bronchial with bronchoscopy veins repeat varices. the no and of resolution had showed patient haemoptysis the Postoperatively further wall. chest the u ihadfeetatooy doahchilar idiopathic aetiology; different a fi with but ihsimilar with rsscuigploayvi occlusion. vein pulmonary causing brosis ▸ erigpoint Learning norptetteewsn hilar no was there patient our In itptooysoe hobsdpulmonary thrombosed showed Histopathology threatening. life be early may whom anticoagulation in systemic embolism risk pulmonary no for with factors patients young be in should considered this and to pathologies secondary non-embolic occur can haemoptysis Massive rnvreC mg hwn etaru with atrium left showing image CT Transverse fi 1 dnst ushv enreported been have ours to ndings fl mainivligtepul- the involving ammation hs clinic Chest fi rssadthe and brosis 2

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on September 27, 2021 by guest. Protected by copyright. by Protected guest. by 2021 27, September on Chest clinic Chest clinic rvnneadpe review peer and Provenance consent Patient interests Competing aucit R Tsa mgsadwiigo h aucit C ugo who surgeon SC: manuscript. the of patient writing operation, and the images performed scan CT GR: manuscript. Contributors 2 hs clinic Chest HM patient KHKM: Obtained. None. ’ olwu,ltrtr erhadwiigo the of writing and search literature follow-up, s ’ olwu n rtn ftemanuscript. the of writing and follow-up s o omsind xenlype reviewed. peer externally commissioned; Not e akrM,ToerM atAP, Maat M, Thomeer MA, Bakker den 2 oaoL oa hhrK ka M, Akbar K, Shahir Sosa, LA Lozano 1 REFERENCES n ig Pathol Diagn Ann hilar pulmonary idiopathic chronic e62 nsa u motn as fmrlndlsi h trachea. the in nodules mural of cause important but unusual – ocsKHK, Morcos 4. 2005;9:319 tal et . Thorax – 22. 2013; fi rsswt nltrlploayvi occlusion. vein pulmonary unilateral with brosis tal et 0 tal et :1 aeo rcelvrcs an varices: tracheal of case A . – .doi:10.1136/thoraxjnl-2012-202869 2. ietraeighmpyi asdby caused Life-threatening . rJRadiol J Br

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