1
|
Murakami T, Otomo Y, Ito T, Sato K, Ohba T. Infectious Pulmonary Artery Pseudoaneurysm Secondary to a Lung Abscess Treated With Pulmonary Artery Coil Embolization: A Case Report. Cureus 2024; 16:e55762. [PMID: 38586669 PMCID: PMC10998975 DOI: 10.7759/cureus.55762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Pulmonary artery pseudoaneurysms (PAPs) are uncommon, yet they frequently result in hemoptysis and are associated with a poor prognosis. We report a case of an 87-year-old male patient. Initially, he was admitted to a previous hospital, and diagnosed with a lung abscess in the left lower lobe. On the second hospital day, he developed hemoptysis. A contrast-enhanced chest computed tomography (CT) identified an infectious pulmonary artery pseudoaneurysm. On the ninth hospital day, pulmonary artery coil embolization was successfully performed, significantly improving the patient's condition.
Collapse
Affiliation(s)
- Takumi Murakami
- Respiratory Medicine, Ome Municipal General Hospital, Tokyo, JPN
| | - Yutaro Otomo
- Respiratory Medicine, Ome Municipal General Hospital, Tokyo, JPN
| | - Tatsuya Ito
- Respiratory Medicine, Ome Municipal General Hospital, Tokyo, JPN
| | - Kenjiro Sato
- Respiratory Medicine, Ome Municipal General Hospital, Tokyo, JPN
| | - Takehiko Ohba
- Respiratory Medicine, Ome Municipal General Hospital, Tokyo, JPN
| |
Collapse
|
2
|
Li XQ, Wu YJ, Wang JZ, Li A, Zheng YL, Yang XJ. Bronchial embolisation for infected pulmonary artery pseudoaneurysms causing haemoptysis. Clin Radiol 2024; 79:e189-e195. [PMID: 37949801 DOI: 10.1016/j.crad.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/24/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
AIM To report the authors' experience of bronchial artery embolisation (BAE) in a series of patients to control haemoptysis associated with infected pulmonary artery pseudoaneurysms (PAPs). MATERIALS AND METHODS All patients who underwent BAE based on computed tomography angiography (CTA) findings indicative of haemoptysis between February 2019 and September 2022 at Xiangyang Central Hospital were identified. Charts of patients with haemoptysis and infectious PAPs were reviewed retrospectively. Data were collected data on age, sex, underlying pathology, source pulmonary artery of the PAP, association with cavitary lesions or consolidation, systemic angiography findings, technical and clinical success, and follow-up. RESULTS Seventeen PAPs were treated in 16 patients, with a mean age of 60.3 years (range: 37-82 years). The most common underlying cause was tuberculosis (15/16, 93.8%). Imaging by CTA did not identify the source pulmonary artery for 15 (88.2%) PAPs; all were associated with cavitary lesions or consolidation. All PAPs were visualised on systemic angiography. The technical and clinical success rates were both 87.5%. Two patients who experienced a recurrence of haemoptysis during follow-up underwent repeat CTA, which confirmed the elimination of the previous PAP. CONCLUSION BAE may be a valuable technique to control haemoptysis associated with infectious PAPs that are visualised on systemic angiography. A possible contributing factor is PAPs arising from very small pulmonary arteries.
Collapse
Affiliation(s)
- X-Q Li
- Department of Interventional Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China
| | - Y-J Wu
- Department of Interventional Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China
| | - J-Z Wang
- Department of Interventional Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China
| | - A Li
- Department of Interventional Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China
| | - Y-L Zheng
- Department of Respiratory and Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China
| | - X-J Yang
- Department of Respiratory and Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China.
| |
Collapse
|
3
|
Karlafti E, Tsavdaris D, Kotzakioulafi E, Kougias L, Tagarakis G, Kaiafa G, Netta S, Savopoulos C, Michalopoulos A, Paramythiotis D. Which Is the Best Way to Treat Massive Hemoptysis? A Systematic Review and Meta-Analysis of Observational Studies. J Pers Med 2023; 13:1649. [PMID: 38138876 PMCID: PMC10744930 DOI: 10.3390/jpm13121649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Hemoptysis is one of the most common symptoms of respiratory system diseases. Common causes include bronchiectasis, tumors, tuberculosis, aspergilloma, and cystic fibrosis. The severity of hemoptysis varies from mild to moderate to massive hemoptysis and can easily lead to hemodynamic instability and death from suffocation or shock. Nevertheless, the most threatening hemoptysis that is presented to the emergency department and requires hospitalization is the massive one. In these cases, today, the most common way to manage hemoptysis is bronchial artery embolization (BAE). METHODS A systematic literature search was conducted in PubMed and Scopus from January 2017 (with the aim of selecting the newest possible reports in the literature) until May 2023 for studies reporting massive hemoptysis. All studies that included technical and clinical success rates of hemoptysis management, as well as rebleeding and mortality rates, were included. A proportional meta-analysis was conducted using a random-effects model. RESULTS Of the 30 studies included in this systematic review, 26 used bronchial artery embolization as a means of treating hemoptysis, with very high levels of both technical and clinical success (greater than 73.7% and 84.2%, respectively). However, in cases where it was not possible to use bronchial artery embolization, alternative methods were used, such as dual-vessel intervention (80% technical success rate and 66.7% clinical success rate), customized endobronchial silicone blockers (92.3% technical success rate and 92.3% clinical success rate), antifibrinolytic agents (50% clinical success rate), and percutaneous transthoracic embolization (93.1% technical success rate and 88.9% clinical success rate), which all had high success rates apart from antifibrinolytic agents. Of the 2467 patients included in these studies, 341 experienced rebleeding during the follow-up period, while 354 other complications occurred, including chest discomfort, fever, dysphagia, and paresis. A total of 89 patients died after an episode of massive hemoptysis or during the follow-up period. The results of the meta-analysis showed a pooled technical success of bronchial artery embolization equal to 97.22% and a pooled clinical success equal to 92.46%. The pooled recurrence was calculated to be 21.46%, while the mortality was 3.5%. These results confirm the ability of bronchial artery embolization in the treatment of massive hemoptysis but also emphasize the high rate of recurrence following the intervention, as well as the risk of death. CONCLUSION In conclusion, massive hemoptysis can be treated with great clinical and technical success using bronchial artery embolization, reducing mortality. Mortality has now been reduced to a small percentage of cases.
Collapse
Affiliation(s)
- Eleni Karlafti
- Emergency Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- 1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (G.K.); (C.S.)
| | - Dimitrios Tsavdaris
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| | - Evangelia Kotzakioulafi
- 1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (G.K.); (C.S.)
| | - Leonidas Kougias
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Georgios Tagarakis
- Department of Cardiothoracic Surgery, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Georgia Kaiafa
- 1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (G.K.); (C.S.)
| | - Smaro Netta
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| | - Christos Savopoulos
- 1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (G.K.); (C.S.)
| | - Antonios Michalopoulos
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| | - Daniel Paramythiotis
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| |
Collapse
|
4
|
Li FQ, Su DJ, Zhang WJ, Chen ZK, Li GX, Li SX, Peng YX, Dang L, Wang WH. Endovascular treatment for massive haemoptysis due to pulmonary pseudoaneurysm: report of 23 cases. J Cardiothorac Surg 2023; 18:244. [PMID: 37580779 PMCID: PMC10426096 DOI: 10.1186/s13019-023-02346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/09/2023] [Indexed: 08/16/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of endovascular treatment for massive haemoptysis caused by pulmonary pseudoaneurysm (PAP). METHODS The clinical data, imaging data, and endovascular treatment protocol of 23 patients with massive haemoptysis caused by continuous PAP were retrospectively analysed. The success, complications, postoperative recurrence rate, and influence of the treatment on pulmonary artery pressure were also evaluated. RESULTS Nineteen patients with a bronchial artery-pulmonary artery (BA-PA) and/or nonbronchial systemic artery-pulmonary artery (NBSA-PA) fistula underwent bronchial artery embolization (BAE) and/or nonbronchial systemic artery embolization (NBSAE) + pulmonary artery embolization (PAE). The pulmonary artery (PA) pressures before and after embolization were 52.11 ± 2.12 (35-69 cmH2O) and 33.58 ± 1.63 (22-44 cmH2O), respectively (P = 0.001). Four patients did not have a BA-PA and/or NBSA-PA fistula. Embolization was performed in two patients with a distal PAP of the pulmonalis lobar arteria. Bare stent-assisted microcoils embolization was performed in the other two patients with a PAP of the main pulmonary lobar arteries. The PA pressures of the four patients before and after treatment were 24.50 ± 1.32 (22-28 cmH2O) and 24.75 ± 1.70 (22-29 cmH2O), respectively (P = 0.850). The technique had a 100% success rate with no serious complications and a postoperative recurrence rate of 30%. CONCLUSION Endovascular treatment is safe and effective for massive haemoptysis caused by PAP. BAE and/or NBSAE can effectively reduce pulmonary hypertension in patients with a BA-PA and/or NBSA-PA fistula.
Collapse
Affiliation(s)
- Fen-Qiang Li
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China.
| | - Dong-Jun Su
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Wan-Jia Zhang
- Department of Vascular and Tumour Intervention, Liangzhou Hospital, Wuwei City, Gansu Province, China
| | - Zhong-Ke Chen
- Department of Interventional Radiology, Affiliated Hospital of Gansu Medical College, PingLiang, Gansu Province, China
| | - Geng-Xiang Li
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Shuang-Xi Li
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Yu-Xing Peng
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Lei Dang
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Wen-Hui Wang
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China.
| |
Collapse
|
5
|
Shaw JA, John TJ, Koegelenberg CFN, Da Silva M, Allwood BW, Weich H. Issues in Medicine. S Afr Med J 2023; 113:65-68. [PMID: 36757074 DOI: 10.7196/samj.2022.v113i2.16758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
Rasmussen aneurysms are abnormalities of the pulmonary arterial system caused by tuberculosis (TB). They are associated with a highmortality rate when they cause life-threatening haemoptysis. High TB-prevalence regions have a large burden of TB-related haemoptysisbut often limited resources. This series of 25 patients who presented with life-threatening haemoptysis from current and/or previous TBwere found to have abnormal pulmonary arteries on computed tomography pulmonary angiogram (CTPA), which were judged to belikely contributors to their bleeding, either in isolation or with concomitant abnormal bronchial or systemic vasculature. These patientsunderwent transcatheter placement of Amplatzer vascular plugs in the feeder pulmonary artery. Bronchial and systemic lesions wereaddressed separately as needed. Immediate technical success was achieved in all patients, but four of them experienced intraoperativehaemoptysis related to dislodgement of the occluding platelet plug by the high-pressure automatic injector and wire. At 48 hours after theprocedure, 18 (72%) remained haemoptysis-free. Six of these experienced recurrence within 1 year of their procedure. Pulmonary arteryplacement of an Amplatzer vascular plug is a feasible option for treating bleeding Rasmussen aneurysms, but should be part of a combinedapproach to addressing suspected culprit vascular lesions in all intrathoracic vascular systems.
Collapse
Affiliation(s)
- J A Shaw
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Biomedical Research Institute, Division of Molecular Biology and Human Genetics, and Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - T J John
- Division of Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - C F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - M Da Silva
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - B W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - H Weich
- Division of Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| |
Collapse
|
6
|
Transcatheter embolization of pulmonary artery pseudoaneurysm secondary to squamous-cell lung cancer. Pulmonology 2022; 29:261-263. [PMID: 36180346 DOI: 10.1016/j.pulmoe.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/17/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
|
7
|
Endovascular Treatment of Central Pulmonary Arterial Pseudoaneurysms in the Context of Silicosis Combined With Pulmonary TB. Chest 2022; 162:894-898. [DOI: 10.1016/j.chest.2022.04.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
|
8
|
Perkutane Embolisation pulmonaler Pseudoaneurysmen. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/a-1556-5409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
9
|
Melo T, Pereira P, Oliveira JA. Treatment of a Post-biopsy Pulmonary Artery Pseudoaneurysm. Cureus 2022; 14:e21411. [PMID: 35223219 PMCID: PMC8862617 DOI: 10.7759/cureus.21411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/24/2022] Open
Abstract
Peripheral pulmonary artery pseudoaneurysms (PPAP) following a lung biopsy are exceedingly rare but can lead to severe haemoptysis. Cases requiring treatment are usually managed using an endovascular approach. Nevertheless, successful percutaneous treatment has been described. Several embolic agents can be used to accomplish percutaneous embolization. We aim to report a successful percutaneous treatment of a post-biopsy PPAP using thrombin. Our patient developed a PPAP, with consequent large alveolar haemorrhage and haemoptysis, after a transthoracic lung biopsy. Because the patient had a mechanical mitral valve, she needed to be anticoagulated, impairing the spontaneous resolution of the pseudoaneurysm. Therefore, the PPAP had to be treated to safely anticoagulate the patient. A percutaneous approach was chosen given the very peripheric location of the PPAP. Treating PPAP with an endovascular approach can be challenging. With this report, we demonstrate that the percutaneous approach is a safe and efficient alternative method. We choose thrombin as an embolic agent given its safety profile and efficacy under anticoagulation. The good results of our intervention reinforce the applicability and efficacy of this kind of treatment approach to PPAP.
Collapse
|
10
|
Extrat C, Grange S, Chevalier C, Williet N, Phelip JM, Barral FG, Le Roy B, Grange R. Safety and efficacy of emergency transarterial embolization for mesenteric bleeding. CVIR Endovasc 2022; 5:5. [PMID: 34997883 PMCID: PMC8742795 DOI: 10.1186/s42155-021-00281-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022] Open
Abstract
Background Patients with spontaneous or traumatic active mesenteric bleeding cannot be treated endoscopically. Transarterial embolization can serve as a potential alternative to emergency surgery. Literature on transarterial embolization for mesenteric bleeding remains very scarce. The objective of this study was to evaluate the safety and efficacy of transarterial embolization for mesenteric bleeding. We reviewed all consecutive patients admitted for mesenteric bleeding to the interventional radiology department, in a tertiary center, between January 2010 and March 2021. Mesenteric bleeding was defined as mesenteric hematoma and contrast extravasation and/or pseudoaneurysm visible on pre-operative CT scan. We evaluated technical success, clinical success, and complications. Results Among the 17 patients admitted to the interventional department for mesenteric bleeding, 15 presented with active mesenteric bleeding requiring transarterial embolization with five patients with hemodynamic instability. Mean age was 67 ± 14 years, including 12 (70.6%) males. Technical success was achieved in 14/15 (93.3%) patients. One patient with technical failure was treated by percutaneous embolization with NBCA-Lipiodol mixture. Three patients (20%) had early rebleeding: two were treated by successful repeat embolization and one by surgery. One patient (6.7%) had early death within 30 days and two patients (13.3%) had late death after 30 days. Mean length of hospitalization was 12.8 ± 7 days. There were no transarterial embolization-related ischemic complications. Conclusion Transarterial embolization is a safe and effective technique for treating mesenteric bleeding even in patients with hemodynamic instability. Transarterial embolization doesn’t close the door to surgery and could be proposed as first intention in case of mesenteric bleeding.
Collapse
Affiliation(s)
- Chloé Extrat
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-En-Jarez, France
| | - Sylvain Grange
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-En-Jarez, France
| | - Clément Chevalier
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-En-Jarez, France
| | - Nicolas Williet
- Department of Gastro-Enterology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Jean-Marc Phelip
- Department of Gastro-Enterology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Fabrice-Guy Barral
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-En-Jarez, France
| | - Bertrand Le Roy
- Department of Digestive and oncologic surgery, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Rémi Grange
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-En-Jarez, France.
| |
Collapse
|
11
|
Chung S, Heo IR, Kim TH, Ju SM, Yoo JW, Lee SJ, Cho YJ, Park SU, Jeon KN, Kim HC. Rasmussen’s Aneurysm, Rare yet Acknowledged Cause of Massive Hemoptysis: Retrospective Review of 16 Cases. KOSIN MEDICAL JOURNAL 2021. [DOI: 10.7180/kmj.2021.36.2.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives: Rasmussen’s aneurysm may cause life-threatening hemoptysis. We investigated the clinical characteristics and outcomes of patients with hemoptysis and Rasmussen’s aneurysm.Methods: We retrospectively investigated patients who clinically presented with hemoptysis and were diagnosed with a Rasmussen’s aneurysm on spiral chest computed tomography (CT).Results: Our study included 16 patients (men:women, 12:4; mean age, 65.25 ± 13.0 years). Massive hemoptysis was observed in nine patients (56%) and blood-tinged sputum in four patients (25%). Ten patients (62.5%) had a history of pulmonary tuberculosis, and three patients (18.7%) had underlying lung cancer. Chest CT revealed coexisting fungal balls in seven patients (43.7%). Bronchial artery embolization (BAE) was performed in 12 patients (75%). One patient died of uncontrolled massive hemoptysis.Conclusions: Patients with Rasmussen’s aneurysm showed hemoptysis during the course of the disease; however, bleeding can be controlled with conservative therapy and radiological interventions, such as BAE.
Collapse
|
12
|
Grange R, Schein F, Grange S. CT-guided percutaneous approach for the treatment of peripheral pulmonary artery pseudoaneurysm: A case report. Radiol Case Rep 2021; 16:3020-3023. [PMID: 34401046 PMCID: PMC8358125 DOI: 10.1016/j.radcr.2021.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/30/2022] Open
Abstract
Pulmonary artery pseudoaneurysm is a rare but life threatening complication of pulmonary tuberculosis, considered as a diagnosis and therapeutic emergency. Transarterial embolization approach has become more widespread over the last few decades, and is now considered the first-line treatment over surgery. Percutaneous embolization under computed tomography (CT) or CT scan control has recently been reported by one centre as a first-line treatment for persistent peripheral Pulmonary artery pseudoaneurysm under certain conditions. We report the case of a 23-year-old female patient admitted in emergency for moderate haemoptysis, in a context of relapsing of tuberculosis. CT scan angiogram showed a peripheral pulmonary artery pseudoaneurysm of the lower left lobe, and persisted seven days later. After multidisciplinary meeting, a minimal invasive approach was decided. The patient was treated in first-line treatment by percutaneous transthoracic embolization, under CT-guidance, using N butyl-cyanoacrylate and Lipiodol mixture, without any complication. The percutaneous minimal invasive treatment seems to be a reliable approach to treat persistent peripheral pulmonary artery pseudoaneurysm.
Collapse
Affiliation(s)
- Rémi Grange
- Department of Radiology, Centre Hospitalier Universitaire de Saint-Etienne, Avenue Albert Raimond, Saint Priest En Jarez, Loire, France
| | - Flora Schein
- Department of infectious diseases, Centre Hospitalier Universitaire de Saint-Etienne, Avenue Albert Raimond, Saint Priest En Jarez, Loire, France
| | - Sylvain Grange
- Department of Radiology, Centre Hospitalier Universitaire de Saint-Etienne, Avenue Albert Raimond, Saint Priest En Jarez, Loire, France
| |
Collapse
|
13
|
Bansal A, Gorsi U, Farook S, Savlania A, Sandhu MS. Interventional radiology management of extremity pseudoaneurysms: a pictorial essay. Emerg Radiol 2021; 28:1029-1039. [PMID: 33988748 DOI: 10.1007/s10140-021-01939-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/01/2021] [Indexed: 11/24/2022]
Abstract
Pseudoaneurysms are vascular abnormalities caused by a damaging force on an arterial wall, resulting in a persistent extravasation of blood into the surrounding tissue, which can be the result of infection, inflammation, trauma or any iatrogenic procedure. The incidence of extremity artery pseudoaneurysms is rising because of increased number of endovascular procedures. As a number of complications are associated with these false aneurysms, it is important to know the treatment modalities available. Ultrasound is the most common method of diagnosing extremity pseudoaneurysm because of their superficial location. Computed tomographic angiography is the next investigation of choice as it has three-dimensional capability and can help evaluate the vascular bed. Digital subtraction angiography is rarely used for diagnosis alone, and is used only when a therapeutic procedure is planned. Treatment of these pseudoaneurysms has shifted from open surgical procedures to minimally invasive treatment in recent years. The different techniques for tackling these lesions include ultrasound-guided compression, percutaneous thrombin or glue embolisation and endovascular coil or stent graft placement. In this pictorial essay, we review the different treatment modalities so that an interventional radiologist is aware of all the treatments he can offer when confronted with these lesions.
Collapse
Affiliation(s)
- Akash Bansal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
| | - Shameema Farook
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Ajay Savlania
- Department of Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| |
Collapse
|
14
|
Lutz N, Grange S, Sanson C, Grange R. Successful embolization of giant pulmonary artery pseudoaneurysm using coils and ethylene vinyl alcohol copolymer (Onyx). Radiol Case Rep 2021; 16:1068-1071. [PMID: 33717384 PMCID: PMC7921184 DOI: 10.1016/j.radcr.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 11/22/2022] Open
Abstract
Hemoptysis could be a life-threatening event, especially when the bleeding originates from the arterial pulmonary circulation. The main cause of this type of bleeding is pulmonary artery pseudoaneurysm (PAP), which can be managed by surgical, medical or minimally invasive techniques. This study reports the case of massive hemoptysis in a 75-year-old male patient, with a former history of lobectomy. The initial CT scan showed a giant PAP from a branch of the right middle lobar pulmonary artery, within the right lower lobectomy cavity. An endovascular approach was decided. Subsequently, the feeding artery of the PAP was embolized with detachable coils. The control CT scan showed a persistent opacification of the PAP. The embolization was then completed by injection of Onyx within coils packing, with a complete thrombose of the PAP on control CT scan. This report confirms the safety and efficacy profile of an endovascular approach to treat giant PAP, using a combination of coils and Onyx.
Collapse
Affiliation(s)
- Noémie Lutz
- Department of Radiology, University Hospital of Saint-Etienne, France
| | - Sylvain Grange
- Department of Radiology, University Hospital of Saint-Etienne, France
| | - Christian Sanson
- Department of Pneumology, University Hospital of Saint-Etienne, France
| | - Rémi Grange
- Department of Radiology, University Hospital of Saint-Etienne, France
- Corresponding author.
| |
Collapse
|
15
|
Muthu V, Singh H, Gorsi U, Agarwal R. Large pulmonary artery pseudoaneurysm in mucormycosis: successfully managed with surgery and amphotericin. BMJ Case Rep 2021; 14:e240813. [PMID: 33468634 PMCID: PMC7817805 DOI: 10.1136/bcr-2020-240813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 01/21/2023] Open
Affiliation(s)
- Valliappan Muthu
- Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harkant Singh
- Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Gorsi
- Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|