Mian Harris Iftikhar

Pulmonary artery stenosis (PAS) is most encountered in the paediatric population as a congenital anomaly. In adults, PAS from extrinsic compression of the pulmonary artery (PA) results from conditions such as fibrosing mediastinitis, malignancy, infections and anastomotic stenosis after lung transplantation. We describe a woman in her 50s with extensive stage small cell lung cancer who presented with symptoms of shortness of breath and hypoxaemic respiratory failure. CT angiography chest showed a progressively enlarging mediastinal mass causing severe compressive stenosis of the right PA and moderate stenosis of the left PA. Her symptoms did not improve despite using bronchodilators and intravenous steroids. Pulmonary angiography confirmed clinically significant stenosis of her right PA. The placement of a single stent within the right PA provided significant improvement in symptoms and supplemental oxygen requirement within 24 hours.

A man in his 30s with a history of cocaine and intranasal heroin use presented to the emergency department with severe leg pain and weakness. Physical examination findings were significant for tachycardia, absence of dorsalis pedis pulses, tense and painful calf muscles along with absence of plantar reflexes in bilateral lower extremities. Laboratory investigations were significant for positive urinary drug screen for cocaine, severe rhabdomyolysis and acute kidney injury. Given the absence of dorsalis pedis pulses in bilateral lower extremities and radiological evidence of oedematous changes in calf muscles with perimuscular oedema, a diagnosis of compartment syndrome was made. He was treated with bilateral lower extremity four-compartment fasciotomies and haemodialysis for acute kidney injury. Rhabdomyolysis has been attributed to cocaine use; however, compartment syndrome is a very rare complication, especially in the absence of trauma or prolonged immobilisation.