2024年 · 第104卷第31期

A 19-year-old male went to the emergency department of Lishui Central Hospital, Zhejiang Province for "repeated hemoptysis for more than 1 year and aggravated for 2 weeks", and invited interventional and vascular surgery consultation. In the past 1 year, the patient has repeated hemoptysis, 2~5 ml each time, bright red color, no fever and chills, no chest tightness and breathlessness, and no night sweats. In the past 2 weeks, the number of hemoptysis increased, and the total amount increased. The previous patients had no history of hypertension, heart disease, kidney disease, cerebrovascular disease, malignant tumor, etc., and no history of anticoagulant use. The parents are in good health, and the patient has 1 brother and 1 sister, all of whom have no relevant medical history. Emergency pulmonary CT angiography (CTA) showed that the thoracic aorta was communicated with the left lower pulmonary vein, and the left lower pulmonary vein was thickened; Minor alveolar bleeding in the lower lobe of the left lung; Multiple thickened and tortuous small vessel branches were seen in the brachiocephalic vein (Figures 1, 2). Consider descending aortic pulmonary venous fistula (DAPVF), which is very rare. There is congenital abnormal development of blood vessels between the descending aorta and the left inferior pulmonary vein, resulting in increased blood supply to the lungs, and then massive hemoptysis and other symptoms, which is a rare chest vascular malformation. At present, there is no clear cause of the disease. Combined with previous case reports, DAPVF can be treated radically according to the surgical method of congenital patent ductus arteriosus, and the effect is good. This patient had a history of repeated hemoptysis. Combined with the CTA image of the patient, the thoracic aorta-left inferior pulmonary vein fistula was finally diagnosed. After abnormal communicating vessel occlusion, the symptoms of the patient were significantly improved.