Aneurysms of the pulmonary arteries

Giant high-pressure pulmonary artery aneurysm in an elderly patient with chronic obstructive pulmonary disease

The authors report the case of a 74-year-old man, with a history of chronic obstructive pulmonary disease (COPD), GOLD grade 3, stable for the past two decades, who was admitted to our center with severe right heart failure. The chest radiograph showed moderate heart enlargement mainly of the right atrium and pulmonary artery, similar to previous chest radiographs in the previous 20 years. The transthoracic echocardiogram showed a pulmonary artery aneurysm (PAA), dilatation of the right chambers with pulmonary artery systolic pressure of 52 mmHg, and preserved right ventricular systolic function. A thoracic computed tomography scan confirmed the presence of a giant PAA 72 mm in diameter. The patient was started on high-dose diuretics, with significant clinical improvement. After optimization of medical therapy right heart catheterization was carried out with the patient in optimal clinical condition, which revealed mild precapillary pulmonary hypertension with a mean pulmonary artery pressure of 26 mmHg. On the basis of the clinical and imaging findings a stable, giant, high-pressure, PAA was diagnosed secondary to pulmonary hypertension induced by COPD, with a 20-year follow-up without need for surgical repair, which helped in our decision to maintain medical surveillance. The recent onset of heart failure is explained by the unfavorable evolution of COPD. This case may change the attitude expressed in previous studies favoring the choice of an invasive approach to treat giant high-pressure PAAs, instead supporting the maintenance of medical treatment.

Unusual Case of Left Bronchial Compression by Aneurysmal Pulmonary Arteries in a Child With Atrial Septal Defect

We report an uncommon case of large ostium secundum atrial septal defect (ASD) with severe pulmonary arterial hypertension, with associated aneurysmal dilatation of the pulmonary arteries (PAs) leading to compression of the left main bronchus and collapse of the entire left lung in a 15-month-old female child. The patient was managed by surgical closure of the ASD, translocation of the right PA anterior to the aorta with PA aneurysmorrhaphy. Left bronchial compression was relieved with complete lung expansion on the third postoperative day.

Development of Pulmonary Artery Aneurysms Due to Behçet's Disease and Resolution after Treatment

We herein describe a patient with Behçet's disease in whom we followed the development and resolution of pulmonary artery aneurysms. He presented with intermittent hemoptysis, pulmonary thromboembolism was initially diagnosed, and anticoagulant therapy was started. Over the next several months, the expansion of pulmonary arteries was noted. Five months after his initial admission, he was readmitted for massive hemoptysis, and further examinations revealed that he had Behçet's disease. Corticosteroids and intravenous cyclophosphamide were started. Over the next five months, the pulmonary artery aneurysms and thrombosis resolved. The development of pulmonary artery aneurysms led to the diagnosis of Behçet's disease, and they resolved after immunosuppressive therapy.

Massive Pulmonary Artery Aneurysm Causing Left Main Coronary Artery Compression in the Absence of Pulmonary Hypertension

We report the case of a 62-year-old woman who presented with classic symptoms of stable angina. Cardiac images and catheterization results revealed absent pulmonary valve syndrome and compression of the left main coronary artery by a massively dilated pulmonary artery aneurysm. The patient's anginal symptoms were relieved after pulmonary arterioplasty. Others have described proximal left main coronary artery compression in the presence of a dilated and hypertensive pulmonary artery. To our knowledge, this is the first case in which a pulmonary artery aneurysm caused left main coronary insufficiency in the absence of pulmonary hypertension-a clinically important complication of congenital pulmonary valve-related pulmonary arteriopathy.

Significance of main pulmonary artery dilation on imaging studies

Proper and early identification of patients who harbor serious occult illness is the first step in developing a disease-management strategy. Identification of illnesses through the use of noninvasive techniques provides assurance of patient safety and is ideal. PA dilation is easily measured noninvasively and is due to a variety of conditions, including pulmonary hypertension (PH). The clinician should be able to thoroughly assess the significance of PA dilation in each individual patient. This involves knowledge of the ability of PA dilation to accurately predict PH, understand the wide differential diagnosis of causes of PA dilation, and reverse its life-threatening complications. We found that although PA dilation is suggestive of PH, data remain inconclusive regarding its ability to accurately predict PH. At this point, data are insufficient to place PA dilation into a PH risk-score equation. Here we review the causes and complications of PA dilation, define normal and abnormal PA measurements, and summarize the data linking its association to PH, while suggesting an algorithm designed to assist clinicians in patient work-up after recognizing PA dilation.

[Huge Solitary Fibrous Tumor of Pleura Combined with Peripheral Pulmonary Artery Aneurysm: A Case Resport]

Solitary fibrous tumor of pleura (SFTP) is uncommon, accounts for less than 5% of all pleural tumors. Pulmonary artery aneurysm (PAA) is also not common, 80% of which often occurs in the main pulmonary trunk and peripheral PAA is rare. SFTP combined with PAA in one patient has not been reported. This paper reports a case of SFTP combined with peripheral PAA, and SFTP maybe accelerate PAA formation.

Mucormycosis causing pulmonary artery aneurysm

Pulmonary artery aneurysm (PAA) is an uncommon entity and is usually congenital in origin or secondary to pulmonary arterial hypertension. Infections causing PAA are few, tuberculosis and bacterial infections being the common causative organisms. There have been few cases reported previously, in which the organism causing PAA was found to be a rare fungus called mucor. Pulmonary mucormycosis causing PAA is an infrequent and almost fatal complication as most of the diagnosis was made post mortem. This report brings out a case of pulmonary mucormycosis causing ruptured PAA in a patient with diabetes. This patient was cured by a timely treatment of a combination of surgery and medical therapy.

Cardiovascular Causes of Pediatric Airway Compression: A Pictorial Review

Airways compression by vascular structures is one of the important comorbidities of congenital heart disease with incidence of approximately 1%-2% in children. Airways compression is a consequence of abnormal configuration of the great vessels producing a vascular ring with enlargement of normal structures (pulmonary arteries or cardiac chambers) or because of surgery. A high index of suspicion for vascular airway compression is important in children with recurrent respiratory complaints. Early diagnosis and management are essential, as chronic airway compression causes significant morbidity. As the underlying anatomical patterns tend to be highly complex, presurgical imaging assessment is essential.

A pulmonary artery pseudoaneurysm caused by concurrent chemoradiation therapy for lung cancer

Pulmonary artery pseudoaneurysms are rarely associated with lung cancer, and to our knowledge, have never been reported as a complication of concurrent chemoradiation therapy for lung cancer. We here report on a 64-year-old man with stage IIIA lung cancer who achieved partial response with concurrent chemoradiation therapy. However, 11 weeks later, he presented with massive hemoptysis, and computed tomography revealed a pulmonary artery pseudoaneurysm. From the findings of this case, we conclude that a pulmonary artery pseudoaneurysm, although rare, warrants attention when concurrent chemoradiation therapy is performed for lung tumors adjacent to the pulmonary artery.

A huge thrombosed pulmonary artery aneurysm without pulmonary hypertension in a patient with hepatosplenic schistosomiasis

BACKGROUND

We herein report a case of huge pulmonary artery aneurysm in a 55-year-old male farmer from the Nile delta (Lower-Egypt), mostly due to infestation with Schistosoma mansoni, which is the parasite causing hepatosplenic schistosomiasis.

CASE REPORT

This male patient was admitted with a month-long history of progressive shortness of breath, 2-month history of fever, and a cough with mucoid sputum for 10 days. On examination, he had normal temperature and blood pressure, but he had tachypnea, tachycardia, and congested neck veins. Electrocardiography showed multifocal atrial tachycardia and right bundle branch block.

CONCLUSIONS

The present case is unique in that it shows the presence of a huge pulmonary artery aneurysm despite the absence of pulmonary hypertension.

Peripheral mycotic pulmonary artery aneurysms

Mycotic pulmonary artery aneurysms are rare but potentially fatal complications of infective endocarditis. The literature on this rare condition was reviewed and its management is discussed.

Giant pulmonary artery aneurysm in a patient with rheumatic mitral stenosis

Pulmonary artery (PA) aneurysm is a rare condition, frequently associated with pulmonary hypertension. However, the evolution and treatment of this pathology is still not clear. We report a case of a 45-year-old female patient with giant PA aneurysm associated with rheumatic mitral stenosis and severe pulmonary arterial hypertension. The patient had undergone balloon mitral valvotomy around 7 years back; aneurysm was first identified 3 years back during routine follow-up. The PA aneurysm size, however, had remained almost unchanged with associated severe pulmonary regurgitation. Surgical correction was advised but denied by the patient. To our knowledge, this is the first case report of such a large PA aneurysm in association with rheumatic heart disease. Although medical therapy for pulmonary hypertension was started, surgical correction of the aneurysm was advised in order to prevent the future complications.

Use of endobronchial ultrasonography in the diagnosis of a pulmonary artery aneurysm

We present the case of an 84-year-old man with nonmassive hemoptysis and an obstructing endobronchial mass who was referred for rigid bronchoscopy and biopsy of the lesion. We illustrate how the pulsatile movement of his endobronchial lesion could be differentiated by convex probe endobronchial ultrasound bronchoscopy to be a vascular lesion rather than an endobronchial mass or tumor. Although convex probe endobronchial ultrasonography has many mediastinal applications, it has yet to be used to characterize endobronchial masses. We describe the first case of using convex probe endobronchial ultrasonography in the diagnosis of a left upper lobe pulmonary artery aneurysm presenting as an endobronchial mass.

[Giant pulmonary artery aneurysm: etiology and an exceptional 17 years natural course]

True pulmonary artery aneurysm (AAP) is rare and represent less than 1% of intra-thoracic aneurysms. We report a case of a AAP in a patient with a likely cor triatrium sinister, with an obstructive membrane responsible for pulmonary hypertension, explaining AAP. The long-term evolution of 17 years is made to an uncomplicated myocardial infarction. The patient died eight months later suddenly probably due to the rupture of the PAA.

Bicuspid Pulmonic Valve and Pulmonary Artery Aneurysm

Bicuspid pulmonary valves and pulmonary artery aneurysms are two rare entities, reported in association, and usually attributed to hemodynamic alterations caused by the bicuspid pulmonary valve. We present magnetic resonance images of a patient with a bicuspid pulmonary valve and pulmonary artery aneurysm, and propose an alternative mechanism for this association, based on recent embryologic studies that link anomalies of the semilunar valves and great vessels with derangement of the cardiac neural crest cell development.

Pulmonary artery aneurysm with patent arterial duct: resection of aneurysm and ductal division

Congenital or acquired aneurysm of the pulmonary artery (PA) is rare. Although aneurysms are described following surgical treatment of patent ductus arteriosus (PDA), occurrence of this lesion in association with PDA without previous surgery is extremely uncommon. An eight-year-old patient with PDA and aneurysm of the main PA is described in this report. Clinical diagnosis of PDA was made upon presentation. Diagnosis of PA aneurysm was suspected on chest x-ray and was confirmed on transthoracic echocardiography. Successful surgical resection of the aneurysm and division of the duct were performed under cardiopulmonary bypass. The patient did well on follow-up both from clinical and echocardiographic point of view.

Spontaneous resolution of post-traumatic pulmonary artery pseudoaneurysm: Report of two cases

Pulmonary artery aneurysm is a rare clinical entity with congenital or mycotic origin being most common causes. Post-traumatic pulmonary pseudoaneurysms are extremely rare. Unless diagnosed early and properly managed, these can be fatal. Only few cases have been reported in the literature with most (except the one) being diagnosed much later after the initial injury and managed surgically. Only one case has been reported following blunt trauma injury, which was diagnosed immediately using computed tomography scan and managed conservatively. Here, we report two cases of pulmonary artery pseudoaneurysm one following gunshot injury and other following blunt injury which was diagnosed on contrast enhanced computed tomography chest and managed conservatively.

Low pressure pulmonary artery aneurysm with atrial septal defect

Pulmonary artery (PA) aneurysm is a rare finding in the thoracic cavity, accompanied by pulmonary hypertension. Clinical presentation of PA aneurysms is usually asymptomatic. The guideline for PA aneurysm treatment is unclear. We report an unusual case of low pressure PA aneurysm associated with atrial septal defect in a 69-year-old man.

Pulmonary Artery Aneurysm Caused by Aspergillus Pneumonia Presenting as an Endobronchial Mass Lesion

We present a case of pulmonary artery aneurysm (PA aneurysm) following Aspergillus fumigatus pneumonia treated by coil embolisation. Although rare, PA aneurysms have a high mortality rate with a large proportion of the cases reported being found at post-mortem examination. Aspergillus infection is known to result in aneurysms in immunocompromised patients and in patients with infective endocarditis. The case we report is unusual in that the patient was not obviously immunocompromised, and initially presented with a different pathology. Treatment by endovascular coil embolisation was successfully employed in this instance, allowing the patient to be weaned from ventilatory support. Although this is an unusual complication of Aspergillus pneumonia, the identification and successful treatment of pulmonary artery aneurysms requires a high-index of suspicion.

Bronchiectasis due to pulmonary artery aneurysm

Pulmonary artery aneurysm (PAA) is a rare entity. We report what we believe to be the first case of bronchiectasis resulting from a PAA, which in turn developed after a previous Senning procedure for transposition of the great vessels during infancy. The patient had bronchiectasis secondary to compression of the left main bronchus because of a PAA. Bronchiectasis is a condition indicating lung resection. Despite the patient receiving medical therapy to treat recurrent pneumonia, lobectomy was necessary to prevent this and other possible complications.

Large pulmonary artery aneurysm associated with Marfan syndrome

Pulmonary artery aneurysms are rare, and published data on the subject are limited. The first case of Marfan syndrome associated with a large pulmonary artery aneurysm complicated by pulmonary artery thrombi and pulmonary hypertension is described. Serial echocardiograms showed progressive dilation of the aneurysm, which reached a massive size of 90 mm. Cardiac catheterization, pulmonary angiography and computed tomography angiography were used in the preoperative evaluation. The patient died suddenly while awaiting a decision for surgical intervention, thereby underscoring the need for aggressive management.

Embolisation of an acute inflammatory pulmonary artery aneurysm using an Amplatzer® vascular plug

Pulmonary artery aneurysms (PAA) are rare. To date there are no cases in the literature describing formation secondary to oesophageal perforation. We present an unusual case of ruptured inflammatory segmental PAA. A patient with oesophageal squamous cell cancer presented with shortness of breath and sepsis following endoscopic dilatation of an oesophageal stricture. Imaging demonstrated oesophageal perforation and a pulmonary parenchymal collection containing an inflammatory PAA. Following initial conservative management, he then re-presented with haemoptysis secondary to PAA rupture. He was treated with embolisation using an Amplatzer® vascular plug (AVP) and went on to make an uneventful recovery.

Bicuspid pulmonary valve with atrial septal defect leading to pulmonary aneurysm

Pulmonary artery aneurysms are rare. We describe 2 adult patients with pulmonary artery aneurysm with normal pulmonary pressure associated with bicuspid pulmonary valve and atrial septal defect. One patient presented with moderate pulmonary valve stenosis and was treated with open surgery; the other patient had a small atrial septal defect and mild pulmonary valve insufficiency and is periodically still being evaluated. Hemodynamic alterations associated with a pulmonary artery aneurysm are described; the influence of additional volume overload and intrinsic wall abnormalities in pulmonary valvular lesions as potential triggers for the development of these aneurysms are analyzed and therapeutic strategies are discussed.

Surgical treatment of a pulmonary artery aneurysm due to a regurgitant quadricuspid pulmonary valve

We report the case of a patient with a pulmonary artery (PA) aneurysm secondary to a regurgitant quadricuspid pulmonary valve, in which both lesions were successfully repaired. The patient, a 16-year old boy, was known to have had pulmonary regurgitation and progressive dilation of the PA for years. He was operated on when he developed symptoms of effort, a dilated right ventricle and a PA of 55 mm. The quadricuspid pulmonary valve was an intraoperative finding. It had a dilated annulus, two normal cusps, a third with a 'sparrow-nest' configuration and the fourth was severely hypoplastic (which explained the valve regurgitation). The valve was repaired through tricuspidisation of the quadricuspid pulmonary valve (annular plication at the level of the hypoplastic cusp, freeing of excedentary tissue from the 'sparrow-nest' cusp and its reattachment to the plicated annulus). The aneurysm was treated through a reduction pulmonary arterioplasty. Early assessment showed the minimal regurgitation of the valve and a normal diameter PA. The outcome was uneventful, with a stable correction after 44 months of follow-up. To our knowledge, this is the first repair of a quadricuspid pulmonary valve, through tricuspidisation.

Ruptured pulmonary artery aneurysm: a surgical emergency

Idiopathic pulmonary artery aneurysm rupture was diagnosed in a 79-year-old man who presented with a dry cough. He was considered unlikely to tolerate extensive pulmonary artery reconstruction or lung resection; hence, he was salvaged by timely ligation of the distal pulmonary artery at the origin of the aneurysm.

Pulmonary artery and vein pseudoaneurysm after gunshot wound to the chest

Traumatic pulmonary artery or vein pseudoaneurysms are extremely rare and angiographic management is gaining grounds. These pseudoaneurysms are caused by both penetrating and blunt chest trauma. We presents a unique case of coexisted pulmonary vein and artery pseudoaneurysm due to penetrating chest trauma managed by angioembolization and inferior vena cava filter insertion for concomitant deep vein thrombosis (DVT) due to contraindication to anticoagulation. The present case represents only the second case of coexisted pulmonary vein and artery pseudoaneurysm and the first with associated DVT making management decision complicated.

Giant pulmonary artery aneurysm in a patient with vasoreactive pulmonary hypertension: a case report

Background

Pulmonary artery aneurysms are a rare condition, frequently associated with pulmonary hypertension. However, the evolution and treatment of this pathology is still not clear.

Case Presentation

The authors report a case of a 65-year old patient with pulmonary artery aneurysm associated with pulmonary arterial hypertension. Due to a positive vasoreactivity test, treatment with calcium channel blockers was started with near normalization of the right cardiac pressures. Nevertheless, after 20 months of treatment, the pulmonary artery aneurysm size remained unchanged with an associated severe pulmonary regurgitation and causing extrinsic compression of the main left coronary artery. Surgical correction was successfully performed.

Conclusions

This is the first case report of a pulmonary artery aneurysm described to be associated with vasoreactive pulmonary hypertension in a living patient. Although medical therapy for pulmonary hypertension was started, surgical correction of the aneurysm was executed in order to prevent its future complications.

Suppurative pericarditis complicated by mycotic aneurysm of the pulmonary artery

Aneurysms of the pulmonary artery are very rare. Here, the authors report the clinical scenario of a middle aged diabetic who presented with suppurative cardiac tamponade that was complicated by mycotic aneurysm of the pulmonary artery. In addition to the clinical presentation, aetiology, diagnostic modalities and therapeutic options are discussed.

A case of left main pulmonary artery aneurysm associated with valvular pulmonary stenosis in a child

Aneurysm of the main pulmonary artery is a rare clinical entity that can be congenital or acquired. Most cases occur in association with other congenital malformations, severe pulmonary hypertension, vasculitides, infectious agents, or collagen vascular disorders. We report here a pediatric case of left pulmonary artery aneurysm associated with valvular pulmonary stenosis and a hypoplastic right pulmonary artery, which we confirmed via multidetector computed tomography angiography.

Treatment of a large pulmonary artery pseudoaneurysm secondary to fungal infection using Amplatzer plugs: New embolisation devices for the management of haemoptysis

Pulmonary artery pseudoaneurysms (PAP) may result in life threatening haemoptysis but are fortunately uncommon. Most are caused by trauma, iatrogenic injury or infection. We describe a case of large PAP secondary to fungal infection in an immunocompromised patient, which was successfully treated percutaneously using Amplatzer embolisation plugs. The technical considerations and advantages of these new devices are explained.

Pulmonary Artery Aneurysmal Dilatation in Adult Patients With Congenital Heart Disease

Background: Aneurysmal dilatation of the main pulmonary artery and its peripheral branches are rare lesions that account for less than 1% of all thoracic aneurysms and have a number of possible pathogenetic causes such as congenital heart disease (CHD), pulmonary artery hypertension, vasculitis, mycotic aneurysm, neoplasm, iatrogenic causes, trauma-related events, or connective tissue abnormalities. Methods: We conducted a retrospective review of the demographic data and the results of clinical examinations, laboratory tests, echocardiography, and angiography of patients managed at the Adult Congenital Heart Disease Unit of the Complejo Hospitalario Universitario Insular—Materno Infantil, between January 2004 and May 2010. Results: A total of 352 adult patients with CHD were studied. Of these, 8 (2.3%) patients had pulmonary artery aneurysmal dilatation (PAAD): 4 with low pressure of the pulmonary artery and 4 with pulmonary hypertension. Only 1 patient showed PAAD-related symptoms. Patients with CHD having PAAD had significantly higher prevalence of pulmonary artery hypertension and higher levels of C-reactive protein (CRP) than those without PAAD (incidence: 4 patients [50%] vs 18 patients [5.2%], P < .000; CRP in mg/dL: 0.52 [0.4; 1.2] vs 0.2 [0.0; 1.6], P = .016). No significant differences were found in cholesterol levels (total cholesterol, low-density lipoprotein [LDL], high-density lipoprotein [HDL], or triglycerides) between CHD patients with or without PAAD. Conclusion: In patients with CHD, PAAD is a rare finding. The PAAD size, etiology, symptoms, and association with pulmonary hypertension should guide decisions on whether conservative or surgical treatment should be applied.

Low-pressure pulmonary artery aneurysm presenting with pulmonary embolism: a case series

Introduction

Pulmonary artery aneurysm is an uncommon disorder with severe complications. The diagnosis is often difficult, since the clinical manifestations are non-specific and the treatment is controversial, as the natural history of the disease is not completely understood.

Case presentation

We describe the cases of two patients with pulmonary artery aneurysms. The first patient was a 68-year-old Caucasian man with an idiopathic low-pressure pulmonary artery aneurysm together with a pulmonary embolism. The patient preferred a conservative approach and was stable at the 10-month follow-up visit after being placed on anti-coagulant treatment. The second patient was a 66-year-old Caucasian woman with a low-pressure pulmonary artery aneurysm also presented together with a pulmonary embolism. The aneurysm was secondary to pulmonary valve stenosis. She received anti-coagulants and, after stabilization, underwent percutaneous balloon valvuloplasty.

Conclusion

Pulmonary embolism may be the initial presentation of a low-pressure pulmonary artery aneurysm. No underlying cause for pulmonary embolism was found in either of our patients, suggesting a causal association with low-pressure pulmonary artery aneurysm.

Hughes-Stovin syndrome

Hughes-Stovin Syndrome (HSS) is a very rare clinical disorder characterized by thrombophlebitis and multiple pulmonary and/or bronchial aneurysms. Less than 40 published cases of HSS have been described in English medical literature so far. The exact etiology and pathogenesis of HSS is unknown; possible causes include infections and angiodysplasia. HSS has also been considered as a variant of Behcet's disease (BD). Patients with HSS usually present with cough, dyspnea, fever, chest pain and haemoptysis. The management of HSS can either be medical or surgical. Medical management includes the use of steroids and cytotoxic agents. Cyclophosphamide, in particular, is a favored therapeutic agent in this regard. Antibiotics have no proven role in HSS while anticoagulants and thombolytic agents are generally contraindicated due to an increased risk of fatal hemorrhage. However, their use may be considered with great care under special circumstances, for instance, intracardiac thrombi or massive pulmonary embolism. For cases of massive hemoptysis due to large pulmonary aneurysms or those with lesions confined to one segment or one lung, lobectomy or pneumectomy can be carried out. However, surgical risks merit serious consideration and must be discussed with the patient. Transcatheter arterial embolization has emerged as a less invasive alternative to surgery in selected cases of HSS. Overall, patients with HSS have a poor prognosis and aneurysmal rupture is the leading cause of death. However, early diagnosis and timely intervention is crucial in improving the prognosis. There is a need to clearly elucidate the genetic, etiologic and pathologic basis for HSS in the future. Although most of the evidence put forward to refute the role of an infectious agent in the etiology and pathogenesis of HSS is based on negative blood and other body fluid cultures, more robust objective assessment is needed through the use of electron microscopy or 16 sRNA studies. The development of better therapeutic agents is also needed to address and prevent the serious consequences arising from pulmonary arterial aneurysms seen in BD and HSS. Also, the issue of anticoagulation in these patients is challenging and requires further deliberation.

[Aneurysmal dilatation of pulmonary artery and its branches on mitral stenosis: a case report]

Pulmonary arteries aneurysms are rare and the rarely described bilateral aneurysms. A 45-year-old patient carrier of mitral stenosis was admitted for dyspnoea class III of the NYHA, chest pain and a not infectious cough. The clinical examination found semiology of mitral stenosis, tricuspid incapacity and pulmonary arterial hypertension. The electrocardiogram showed atrial fibrillation and right ventricle hypertrophy. Chest X-ray found a cardiomegaly, an aspect of double outline of the inferior right bow, a prominent aspect of the left average bow reminding an aneurysm of the left pulmonary artery. The echocardiography Doppler found a pure tight mitral stenosis (mitral surface=0.6 cm(2)), a dilation of the trunk of the pulmonary artery (diameter=74 mm) and of its branches (diameter of the right pulmonary artery=28 mm, diameter of the left pulmonary artery=36 mm) seat of a spontaneous contrast. The left atrium and right cardiac cavities were also dilated. There was an important tricuspid incapacity with a major pulmonary hypertension (systolic pulmonary arterial=109 mmHg). The thoracic angioscan showed a pseudoaneurysm of the trunk of pulmonary artery and its branches to their distal parts. Under diuretic, anticoagulating and analgesic treatment the clinical signs improved however the spontaneous contrast persisted. The patient was rejected by the surgery for exceeded clinical board. She is at present followed in our service for 5 months.