Hemoptysis due to progressive scoliosis associated with congenital heart disease: a case report

Abstract

Background: Patients with congenital heart disease (CHD) are associated with an increased incidence of scoliosis, often with severe progression. We report a case of hemoptysis caused by rapid scoliosis progression subsequent to surgery for CHD that was successfully managed by surgical curve correction following coil embolization.

Case presentation: A 14-year-old girl with scoliosis had undergone open heart surgery for CHD at the age of 1 year. She was first noted to have scoliosis at 12 years of age, which began to progress rapidly. At age 13, her main thoracic curve Cobb angle was 46°, and hemoptysis with high pulmonary vein pressure due to vertebral rotation was detected. Nine months after coil embolization, she received posterior spinal fusion from T5 to L2 for scoliosis correction. Postoperatively, her pulmonary vein diameter was enlarged, with no detectable signs of hemoptysis.

Conclusions: We encountered a case of hemoptysis caused by advanced scoliosis after cardiac surgery that was successfully treated by correction of the scoliotic curve following coil embolization. Patients with secondary scoliosis after surgery for CHD should be carefully monitored for the possibility of cardiovascular system deterioration.

Keywords: Congenital heart disease; Hemoptysis; Pulmonary vein stenosis; Scoliosis; Spinal correction.

Fig. 1

Changes in preoperative radiographs. At age 13, her main thoracic curve had a Cobb angle of approximately 46 degrees, with episodes of hemoptysis

Fig. 2

Coil embolization. Collateral blood flow from the left bronchial artery to the left pulmonary vein necessitated coil embolization

Fig. 3

Preoperative contrast CT. Lateral deviation and right anterior rotation of the T8 vertebral body were evident. The descending aorta appeared to be draining in close proximity to the left pulmonary vein (circles)

Fig. 4

Pre- and postoperative radiographs. Radiographs showed that the correction rate of the main thoracic curve was 72% and thoracic kyphosis angle had increased by 15 degrees

Fig. 5

Pre- and postoperative CT. CT indicated that vertebral body rotation angle was slightly decreased from 10.5 degrees to 10.0 degrees at T8, which was the apical vertebra

Fig. 6

Changes in pre- and postoperative contrast CT. A midline and posterior shift of the T8 vertebral body relative to the sternum (blue circle) as compared with preoperative images (red circle)