https://orcid.org/0000-0002-6052-221X
A 74-year-old male farmer was referred to our centre due to progressive dyspnoea and refractory pleural effusion. Over the past 3 years, he has undergone more than 12 thoracentesis procedures to alleviate symptoms associated with massive pleural effusion. Furthermore, he has experienced a 20-kg weight loss. Upon admission, physical examination revealed poor nourishment [body mass index (BMI): 13.4 kg/m2] and a significant left-sided pleural effusion. The initial diagnostic work-up indicated moderate silicosis, respiratory failure, transudative pleural effusion, and severe pulmonary hypertension (pulmonary artery systolic pressure: 79 mm Hg). Computed tomography pulmonary angiography showed abnormal soft tissues in the mediastinum, which wrapped and compressed the pulmonary arteries, pulmonary veins (PV), and bronchi (Panels A–C). Consequently, the patient was diagnosed with fibrosing mediastinitis.
Pulmonary vein angiography revealed severe stenosis in the proximal left superior PV and proximal left inferior PV (Panels D and G). Following sequential balloon dilation, bare-metal stents (10 × 19 mm) were successfully implanted in the left superior PV and left inferior PV (Panels E, F and H, I; see Supplementary data online, Video S1). Post-operatively, the pressure in the pulmonary artery, left superior PV, and left inferior PV decreased dramatically (53/17 vs. 35/16 mm Hg; 46/32 vs. 8/0 mm Hg; 28/16 vs. 9/4 mm Hg). Subsequent chest computed tomography performed 4 days after stenting confirmed the disappearance of the refractory effusion, leading to continued improvement in the patient’s symptoms. He was discharged on the seventh day with clopidogrel and rivaroxaban. During the 4-month follow-up, the patient remained in good health without any recurrence of symptoms.
Supplementary data are available at European Heart Journal online.
All authors declare no disclosure of interest for this contribution.
The data underlying this article are available in the article and in its online supplementary material.
