PDF(Pubmed)
Abstract：
This case centers on a 76-year-old male experiencing exertional dyspnea and hemoptysis, with a medical history marked by recurrent pulmonary embolism and chronic obstructive pulmonary disease (COPD). Notably, he resides in a histoplasmosis-endemic area. A computed tomography (CT) pulmonary embolism scan revealed notable findings, including an enlarged right lower pulmonary artery, vascular congestion, atelectasis, and a mass exerting pressure on the right lower pulmonary vein. Biopsy results identified the mass as fibrosing mediastinitis, likely attributed to histoplasmosis. A transthoracic echocardiogram indicated right ventricular dilatation, impaired function, and a right ventricular systolic pressure of 63 mm Hg. During right heart catheterization, the patient displayed disparate pulmonary artery wedge pressures (PAWPs) between the right and left sides. This discrepancy was linked to a blunted back wave from the left atrium to the catheter, induced by pulmonary vein compression. Although an infrequent phenomenon, the recorded asymmetry in PAWPs played a crucial role in guiding accurate patient management. The absence of subsequent evaluation of PAWP on the left side could have altered the treatment plan, potentially delaying appropriate patient care. This case emphasizes the necessity of thorough exploration with right heart catheterization when clinical symptoms warrant, highlighting the importance of standardized practices in such procedures.
摘要：
该病例以一名76岁男性为中心，患有劳力性呼吸困难和咯血，具有以复发性肺栓塞和慢性阻塞性肺疾病（COPD）为特征的病史。值得注意的是,他居住在组织胞浆菌病流行区。计算机断层扫描（CT）肺栓塞扫描显示明显的发现，包括扩大的右下肺动脉,血管充血,肺不张,和对右下肺静脉施加压力的肿块。活检结果确定肿块为纤维化纵隔炎，可能归因于组织胞浆菌病。经胸超声心动图显示右心室扩张，功能受损，右心室收缩压为63mmHg.在右心导管插入术中,患者在左右两侧显示不同的肺动脉楔压(PAWP).这种差异与从左心房到导管的迟钝的背波有关，由肺静脉压迫引起。虽然这是一种罕见的现象，记录的PAWP不对称性在指导准确的患者管理方面起着至关重要的作用.左侧缺乏随后的PAWP评估可能会改变治疗计划，可能会延迟适当的患者护理。该病例强调在临床症状允许的情况下进行右心导管彻底探查的必要性，强调标准化做法在此类程序中的重要性。
