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Bronchial varices in a child with tricuspid atresia six years post Fontan correction
Shreya Bhushan1, Vikas Goyal1, Cameron Ward2
1Department of Respiratory and Sleep Medicine Queensland Children's Hospital Brisbane QLD Australia.
Insights
Bronchial varices, rare in children, can occur after Fontan procedures. Embolization may resolve hemoptysis but not always the varices themselves.
Area of Science:
- Pediatric Cardiology
- Vascular Pathology
- Interventional Pulmonology
Background:
- Tracheal and bronchial varices are uncommon in pediatric populations.
- These vascular anomalies are typically associated with adult conditions like Fontan circulation failure, portal hypertension, or pulmonary hypertension.
Observation:
- A case of hemoptysis and bronchial varices is presented in a child six years post-Fontan procedure for tricuspid atresia.
- Imaging revealed tortuous mediastinal and transpleural arterial collaterals.
Findings:
- The child underwent successful embolization of the identified arterial collaterals.
- Post-embolization, hemoptysis resolved, but bronchial varices persisted upon repeat bronchoscopy.
Implications:
- This case highlights the potential for bronchial varices post-Fontan procedure in children.
- While embolization can manage hemoptysis, persistent varices may require further monitoring or management strategies.
Abstract:
Tracheal and bronchial varices are rarely found in children. However, they have been described in adults with failing Fontan circuits or secondary to vascular pathology, such as portal and pulmonary hypertension. We report the presentation of haemoptysis and bronchial varices in a child, six years after a Fontan procedure for tricuspid atresia. She had tortuous mediastinal and transpleural arterial collaterals on computed tomography (CT) angiography and cardiac catheterization and subsequently underwent embolization of these collaterals. While the haemoptysis settled post embolization, the bronchial varices persisted on repeat bronchoscopy. She has since been clinically well with no further haemoptysis.
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