Jimu news reporter Liu Xun
Correspondent Lu Hui Song Meng
Henan's Shi Daddy chest tightness, repeated cough for medical treatment, has been diagnosed as coronary heart disease, treatment for a long time has not improved, transferred to Wuhan Asian Heart Hospital only to find that the "culprit" is not coronary heart disease, but the fracture after the healing of fibrous mediastinitis, and then cause pulmonary artery stenosis. After implanting a stent in the pulmonary artery, the elderly are currently reviewing the indicators well and have returned to normal life.
Peel off the cocoon and look for the cause
Shi Daddy is 70 years old this year, and he has always had the "old problem" of chest tightness, and the symptoms come and go quickly, and he doesn't care too much. It wasn't until two years ago that chest tightness continued to worsen, accompanied by cough, that Daddy Shi made up his mind to go to the hospital. "I went to several hospitals and said it was coronary heart disease, and I insisted on taking medicine every day, but I just didn't see it better." In order to find the root cause of the disease, the old man came to Wuhan Asian Heart Hospital for treatment.
Coronary angiography showed that the coronary artery blood vessels of the elderly were basically smooth and there were no obvious lesions. Excluding coronary heart disease, what kind of disease caused Daddy's symptoms? After repeated discussions, doctors suspected that it may be pulmonary vascular disease, which is one of the most likely diseases to occur in the elderly population in addition to coronary heart disease.
Papa Shi then did a CT of pulmonary vascular enhancement, and the results confirmed the doctor's conjecture. The lower left pulmonary artery, which was supposed to grow normally in the mediastinal cavity, was encased in hypertrophic fibrous tissue, causing pulmonary artery stenosis. It turned out that Shi Daddy's fracture experience two years ago had become the key to cracking the "truth".
Daddy's left lower pulmonary artery is surrounded by fibrous tissue hyperplasia and narrows
"Our initial diagnosis is that Daddy May have fibrous mediastinitis, which is characterized by hyperplasia of fibrous tissue in the mediastinum and compression of important structures such as blood vessels, bronchi or esophagus in the mediastinum, of which pulmonary artery compression is the most common. Tuberculosis, histoplasmosis infection, trauma, iatrogenic factors, and other causes can lead to mediastinal fibrosis. Jin Bowen, a doctor at the Xianxin Disease Center of Wuhan Asian Heart Hospital, introduced that Shi Daddy had fractured his left rib 2 years ago, although the fracture healed well after treatment, but the trauma at that time led to the proliferation of fibrous tissue in the mediastinum, which caused stenosis around the pulmonary artery.
In order to further clarify the diagnosis, the elderly then underwent a right heart catheter and pulmonary angiography examination, and found that there was a narrowing of the left lower pulmonary artery, and the cardiac catheter measurement pressure level difference was as high as 30 mm Hg, and only a quarter of the blood carrying oxygen in the whole body flowed to the whole body, and the oxygen supply to the body was insufficient, resulting in repeated chest tightness and cough symptoms.
Stent is implanted and symptoms disappear
After the results of the right heart catheterization and pulmonary angiography came out, Daddy Shi's surgery was also initiated. In the face of the narrowing of blood vessels caused by Papa's fibrous mediastinitis, due to the relatively hard fibrous tissue of hyperplasia, it is difficult to completely open the narrow blood vessels by simply using the balloon, and after the balloon is withdrawn, the blood vessels that are briefly propped open automatically retract, and the stenosis appears again. Under the precise positioning of the interventional image, the chief surgeon Jin Bowen resolutely inserted a metal stent into The Stenosis Pulmonary Artery, successfully supported the "oxygen supply lifeline", and the narrowed pulmonary artery finally returned to patency.
Dr. Bowen Kim (left) performs surgery on Daddy Shi
Significant stenosis of the pulmonary arteries before surgery (left), patency of the pulmonary arteries after surgery (right)
After the operation, Daddy Shi recovered quickly and was discharged from the hospital two days after the operation. He has been standardizing the use of drugs under the guidance of doctors, not only the symptoms of chest tightness and shortness of breath have disappeared, but the whole person has also become full of energy. "Thanks to the doctors for their precise diagnosis, thanks to you, I can recover so well." Coming to the hospital to review this day, Daddy Shi said gratefully.
Fibrous mediastinitis is a difficult disease with a cause and mechanism that has not been fully defined, and the narrowing of pulmonary vessels caused by it can cause pulmonary hypertension and right heart failure, due to the lack of specificity of its clinical symptoms, it is easy to misdiagnose or miss diagnosis like Daddy Shi. In recent years, there have been new advances in the diagnosis and treatment of pulmonary vascular stenosis caused by fibrous mediastinitis, CT pulmonary angiography is the preferred method for diagnosing patients with suspected fibrous mediastinitis, and stent implantation treatment is a powerful means to relieve stenosis and improve symptoms.
Dr. Jin Bowen said that stent surgery can not only treat narrowing caused by fibrostinitis, but also treat diseases such as lung artery and venous stenosis caused by other causes. It is reported that Wuhan Asian Heart Hospital is one of the earliest hospitals in Hubei Province to carry out pulmonary vascular stenting surgery, and since 2019, it has matured several cases, bringing more treatment options to patients.