Recurrent hemoptysis following a systemic-to-pulmonary anastomosis in a child with a complex congenital cardiomyopathy.

Abstract

A 14-year-old boy with a history of congenital cardiopathy is presented. At age 4, a left systemic-to-pulmonary fistula was performed, using a tubular prosthesis to anastomose the left subclavian artery to the left pulmonary artery. Following this procedure, he developed recurrent episodes of hemoptysis, cough, and left upper lobe consolidation. Treatment resulted in clinical but no radiologic resolution. At age 6, a new right systemic-to-pulmonary anastomosis was needed, as the left one was no longer functioning. After placement of the second shunt, the hemoptysis disappeared. At age 14, flexible bronchoscopy revealed a foreign body granuloma at the left secondary carina. Rigid bronchoscopy and laser photoresection showed it to be the left vascular prosthesis, placed 10 years before. Surgery failed to remove it.