pleuropulmonary actinomycosis associated with a systemic-to-pulmonary artery fistula and contralateral metastatic back mass

Thoracic Actinomycosis

“…35 Rare development of acquired infectious systemic to pulmonary circulation fistulas have been reported in actinomycosis. 24 Affected arterial vessels include the intercostal, 36,37 internal mammary, 15 and bronchial arteries. 38 Solitary infection of the bronchial mucosa without pulmonary parenchymal involvement has been observed with actinomycosis.…”

Use of Coils and a Pulmonary Vasodilator to Reduce Pulmonary Hypertension in a Patient with Interstitial Pneumonia and Scleroderma

“…A cardiopulmonary exercise test showed mild improvement in the maximum VO2 (10.8 mL/min/kg) and METS at peak (3.0 METS). An RHC for post-occlusion evaluation showed that mPAP and PCWP had been decreased to 31 and 9 mmHg, respectively, with no change in the PVR (635 dyn·s/cm 5 ). Unexpectedly, the to-and-fro contrast filling pattern and O2 step up could still be seen in the pulmonary arteries of the left lower lobe.…”

“…This condition can be congenital or acquired through several etiologies including lung infection (e.g. tuberculosis/actinomycosis), bronchiectasis, pulmonary arterial obstruction, neoplasia, or trauma/surgery (1,(3)(4)(5)(6)(7). Several case reports have indicated that SA-PAF can cause PH because of systemic to pulmonary artery shunts that are created by fistulas, but no reports have shown an efficacy of pulmonary vasodilators.…”