Pulmonary venous aneurysm presenting as a middle mediastinal mass

Rare and potentially lethal case of a round lesion in the lung

A pulmonary venous aneurysm (PVA) is extremely rare. A PVA can be either congenital or acquired. Possible symptoms include thoracic pain, dyspnoea, haemoptysis and palpitations but can also occur asymptomatically. Treatment can be conservative or surgical depending on growth and risk of rupture or development of mitral insufficiency, symptoms and thrombus formation. Only a few cases have been described in the literature. A recent case study and a literature review are described below.

A lung cyst harbouring a congenital pulmonary varix

A non-smoker man in his second decade presented to a medical centre with intermittent haemoptysis over 2 years. The haemoptysis was infrequent initially to be ignored, but later, the episodes increased in amount and frequency. Routine blood tests including coagulation profile showed normal results. The chest radiography and echocardiography were normal. The contrast-enhanced CT scan of the chest showed a cystic lesion with intracystic abnormality and surrounding ground-glass opacity in the left upper lobe. The CT pulmonary angiography and invasive pulmonary angiography showed the abnormality to be a dilated pulmonary vessel draining into the left atrium, thereby confirming the diagnosis of congenital pulmonary varix contained within a lung cyst. The patient underwent a successful lobectomy following which he experienced no further haemoptysis.

Management of asymptomatic pulmonary vein aneurysm

Aneurysm of a pulmonary vein is a rare vascular anomaly that is usually discovered incidentally as a pulmonary nodule or mediastinal mass. Most patients do not have any symptoms but some patients can present with dyspnea, hemoptysis, or cerebral thromboembolism. Proper diagnosis is crucial as to avoid unnecessary testing or surgical procedures. We highlight a case of an asymptomatic 59-year-old female with a pulmonary vein aneurysm presenting as a 1.5 cm right infrahilar nodule on contrast-enhanced CT during evaluation for acute cholecystitis. Further investigation with MRA revealed that it was vascular in nature, and pulmonary angiography showed dilation of the right inferior pulmonary vein with no communication to the pulmonary artery. On serial imaging, there has been no change in the size of the aneurysm. A small non-enlarging pulmonary vein aneurysm should be managed expectantly.

Pulmonary venous aneurysm: Forming a glove balloon-like shape

INTRODUCTION

Pulmonary venous aneurysm (PVA) is a candidate for surgery because of the risk of rupture and continued growth even if the patient does not develop mitral valve disorders.

PRESENTATION OF CASE

We report the case of PVA that continued to increase in size throughout a 17-year observational period.

DISCUSSION AND CONCLUSION

The location and form of the aneurysm are important to consider when choosing the surgical approach. If the aneurysm forms a "glove balloon-like shape," lobectomy is necessary because end-to-end anastomosis is difficult to perform in such cases.

Etiology of pulmonary venous aneurysm diagnosed by a combination of echocardiography and contrast-enhanced computed tomography: a case report

Pulmonary venous aneurysm is rare and its etiology is still debated. Some studies have shown that acquired aneurysms are caused by an increase in left atrial pressure and mitral regurgitation. However, few reports have provided direct evidence of this pathology. We present a case of pulmonary venous aneurysm diagnosed using a combination of echocardiography and contrast-enhanced computed tomography with strong evidence for an etiology of severe mitral valve regurgitation. A 24-year-old Chinese man was diagnosed with mitral valve perforation with severe mitral regurgitation caused by infectious endocarditis. A right inferior pulmonary venous aneurysm was diagnosed by contrast-enhanced computed tomography. Color Doppler echocardiography revealed a mitral regurgitation jet filling the giant aneurysm. Three-dimensional echocardiography provided a clear stereoscopic view of the aneurysm. These imaging modalities provided direct evidence for the etiology of the pulmonary venous aneurysm.

Vascular lesions of the mediastinum

Most mediastinal masses seen on thoracic imaging are of solid tumor origin. As such, vascular lesions of the mediastinum can be mistaken for, or misinterpreted as, one of these more common mediastinal masses. This article stresses the importance of considering vascular entities in the differential diagnosis of mediastinal masses.

Pulmonary venous aneurysm presenting as a mediastinal mass in ischemic cardiomyopathy

True aneurysm of the pulmonary vein is a rare lesion and may present as a mediastinal mass. Acquired aneurysm of the right superior pulmonary vein presenting as a middle mediastinal mass in a patient with ischemic cardiomyopathy associated with severe mitral regurgitation and dilated left atrium is described. Though the natural history of this lesion is uncertain, it may progressively enlarge and become symptomatic. Presence of this lesion in this patient with cardiomyopathy may require a modification of surgical technique at cardiac transplantation or surgical resection of an aneurysm without cardiopulmonary bypass.