Hémoptysie grave, retour veineux pulmonaire anormal partiel et hypertension artérielle pulmonaire

A 73-year-old man with chronic respiratory insufficiency was referred to the intensive care unit because of life threatening haemoptysis and hypoxemia. The patient was in respiratory failure with pulmonary arterial hypertension. The bleeding was issuing from the left inferior lobe. A small arterio-venous fistula was suspected on tomodensitometry. Arterial embolization was contraindicated because of diffuse vascular disease. A left inferior lobectomy was performed. The left superior pulmonary vein was draining into the brachiocephalic vein forming a partial anomalous pulmonary venous return. An anatomic restoration of the venous return to the left atrium was performed. The postoperative course was uneventful. No recurrence of haemoptysis was observed, after 9-month follow-up the vascular anastomosis was patent. Despite the pulmonary vascular bed reduction following lobectomy, echocardiography showed a globally mild improvement of cardiac status that might be attributed to right heart preload amelioration.