Chronic Pancreatitis: A Rare Cause of Hemoptysis by the Inferior Phrenic Artery

Document Type

Conference Proceeding

Publication Date

5-21-2023

Publication Title

Am J Respir Crit Care Med

Abstract

Introduction: Most known cases of systemic-pulmonary anastomoses causing hemoptysis involve the bronchial arteries and have been known to occur in patients with chronically inflamed lungs or those with recurrent infection. Chronic pancreatitis causing hemoptysis due to invasion of the inferior phrenic artery (IPA) into the pleural space is a very rare complication with only one other case reported in the literature. The suggested pathophysiology relates to the extension of pancreatic enzymes into the pleural space leading to inflammation. HPI: A 36 year old male with a past medical history of left lower lobe pneumonia a year prior to presentation and alcohol use disorder complicated by multiple bouts of pancreatitis and known pancreatic pseudocysts presented with a chief complaint of hemoptysis. The gentleman states that he was initially experiencing a cough that persisted for over two months, but over the past 5 days prior to his presentation he began developing hemoptysis, which prompted his visit to the hospital. Hemodynamically, the gentleman was normotensive and afebrile. He initially presented with a hemoglobin (Hb) of 7.3, which was below his baseline. Given his history of pneumonia and current presentation of hemoptysis, CT chest with IV contrast was ordered and demonstrated tortuous systemic arterial branches supplying the inferior aspect of the left lower pulmonary lobe. These branches arose from the celiac trunk, and represent a hypertrophied left inferior phrenic artery that was supplying the left lower pulmonary lobe. This connection was secondary to recurrent pancreatitis as evident by the pseudocyst formation abutting the left hemi-diaphragm. IR was consulted upon the patient's admission and performed a diagnostic angiography of the left IPA that confirmed shunting into the left pulmonary arteries. This aberrant connection favored to be the cause of the patient's hemoptysis. Embolization of the IPA, which predominantly supplied the shunt, along with its distal branches was performed. Discussion: In our case, direct contact of the pancreatic pseudocysts with the diaphragm led to pleural inflammation and subsequent formation of systemicpulmonary anastomoses. Identification of this rare complication is critical because the management differs from most other cases of hemoptysis due to aberrant connections.

Volume

207

Issue

1

Find It @ Sladen

Share

COinS