Systemic-to-pulmonary venous shunt in a haemodialysis patient

Michel Tintillier1, Nicolas de Suraÿ1, Frédéric Alexis2, Isabelle Mathy3 and Emmanuel Rombaut4

1 Clinique Sainte Elisabeth, Nephrology, NAMUR, 2 Clinique Sainte Elisabeth, Radiology, Namur, 3 Clinique Sainte Elisabeth, Neurology, Namur and 4 Clinique Sainte Elisabeth, Cardiology, Namur, Belgium

Correspondence and offprint requests to: Michel Tintillier, clinique Sainte Elisabeth, Nephrology, NAMUR, Belgium. Email: m.tintillier{at}ibelgique.com

A 56-year-old haemodialysis patient was admitted for dysarthria in September 2003. He had been treated by haemodialysis since the age of 54. Because of arterio-venous fistula failures, multiple central catheters had been used. In March 2003, at the last catheter placement, angiography disclosed superior vena cava (Figure 1A, black arrow) and innominate vein (Figure 1A, white discontinuous arrow) stenoses. At admission, diagnosis of transient ischaemic attack was suspected, and accordingly, a contrast trans-oesophageal echocardiography was performed which showed no atrial thrombus, but micro-bubbles entering massively the left atrium from left superior pulmonary vein. Computed angiotomography showed collateralization between hemi-azygos vein through left superior intercostal vein (Figures 1A and B, with continuous arrow) and left superior pulmonary vein (Figure 1B, white discontinuous arrow), secondary to superior vena cava and innominate vein stenoses.



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Fig. 1.

 
These systemic-to-pulmonary venous shunts are usually caused by malignant tumours, but rarely by benign conditions, as in this case, and may be at the origin of paradoxical embolisms.

The evolution of our patient was rapidly and spontaneously favourable. He was already under acenocoumarol therapy, which was continued.

Conflict of interest statement. None declared.





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