A rare aneurysm of the brachiocephalic vein causing chronic thromboembolic pulmonary hypertension
Year: 2024
Type: article
Study design: Case Report
Abstract: A 29-year-old female patient was admitted to our ward with pneumonia. Six months before presentation, she suddenly experienced dyspnoea on minimal exertion. Because of respiratory deterioration during her admission, a computed tomography (CT) scan was performed. The CT scan showed obstruction of the lower pulmonary arteries bilaterally with signs of increased pressure on the right side of the heart. An aneurysm of the brachiocephalic vein was detected (Panel A). The aneurysm was considered to be the cause of the pulmonary emboli, as there was no evidence for venous thrombosis. After treatment with anticoagulants for 3 months, there was no clinical improvement. She was screened for pulmonary hypertension. Ventilation/perfusion scans showed a mismatch of perfusion in both lower lobes. A pulmonary angiography confirmed the absence of blood flow in the lower lobes of both lungs (Panel B). Echocardiography showed flattening of the intraventricular septum and a maximal tricuspid regurgitation velocity of 3.85 m/s. Right heart catheterization showed a mean pulmonary artery pressure (mPAP) of 33 mmHg. She was started on macitentan and accepted for surgical resection of the aneurysm (Panels C and D), combined with a pulmonary endarterectomy (Panel E). The surgery went well. Three months after surgery, macitentan was discontinued. The right heart catheterization 6 months after surgery showed normal mPAP of 18 mmHg. Aneurysms of the brachiocephalic vein are rare, with only 36 cases reported in literature. It is associated with an increased risk of (chronic) pulmonary embolism, rupture, and venous obstruction. Funding: None declared. Data availability: No new data were generated or analysed in support of this manuscript.
Institutions: St. Antonius Ziekenhuis, University Medical Center Utrecht
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4401657150