1
|
Claudinot A, Douane F, Morla O, Perret C, Neveu M, Thouveny F, Bouvier A, Hureaux J, Le Guen A, Jouan J, Heautot JF, Larralde A, Cerasuolo D, Bergot E, Fohlen A, Pelage JP. Pulmonary Artery Embolization in the Management of Hemoptysis Related to Lung Tumors. J Pers Med 2023; 13:1597. [PMID: 38003912 PMCID: PMC10672290 DOI: 10.3390/jpm13111597] [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: 09/30/2023] [Revised: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Bronchial artery embolization has been shown to be effective in the management of neoplastic hemoptysis. However, knowledge of pulmonary artery embolization is lacking. The aim of this study was to evaluate the safety and efficacy of pulmonary artery embolization in patients presenting with hemoptysis related to lung tumors. (2) Methods: This retrospective study reviewed all consecutive patients with cancer and at least one episode of hemoptysis that required pulmonary artery embolization from December 2008 to December 2020. The endpoints of the study were technical success, clinical success, recurrence of hemoptysis and complications. (3) Results: A total of 92 patients were treated with pulmonary artery embolization (63.1 years ± 9.9; 70 men). Most patients had stage III or IV advanced disease. Pulmonary artery embolization was technically successful in 82 (89%) patients and clinically successful in 77 (84%) patients. Recurrence occurred in 49% of patients. Infectious complications occurred in 15 patients (16%). The 30-day mortality rate was 31%. At 3 years, the survival rate was 3.6%. Tumor size, tumor cavitation and necrosis and pulmonary artery pseudoaneurysm were significantly associated with recurrence and higher mortality. (4) Conclusions: Pulmonary artery embolization is an effective treatment to initially control hemoptysis in patients with lung carcinoma, but the recurrence rate remains high and overall survival remains poor.
Collapse
Affiliation(s)
- Amandine Claudinot
- Department of Radiology, CHU de Caen, 14000 Caen, France; (A.F.); (J.-P.P.)
| | - Frédéric Douane
- Department of Radiology, CHU de Nantes, 44000 Nantes, France; (F.D.); (O.M.); (C.P.); (M.N.)
| | - Olivier Morla
- Department of Radiology, CHU de Nantes, 44000 Nantes, France; (F.D.); (O.M.); (C.P.); (M.N.)
| | - Christophe Perret
- Department of Radiology, CHU de Nantes, 44000 Nantes, France; (F.D.); (O.M.); (C.P.); (M.N.)
| | - Marine Neveu
- Department of Radiology, CHU de Nantes, 44000 Nantes, France; (F.D.); (O.M.); (C.P.); (M.N.)
| | - Francine Thouveny
- Department of Radiology, CHU d’Angers, 49933 Angers, France; (F.T.); (A.B.); (J.H.)
| | - Antoine Bouvier
- Department of Radiology, CHU d’Angers, 49933 Angers, France; (F.T.); (A.B.); (J.H.)
| | - José Hureaux
- Department of Radiology, CHU d’Angers, 49933 Angers, France; (F.T.); (A.B.); (J.H.)
| | - Arnaud Le Guen
- Department of Radiology, Centre Hospitalier Bretagne Atlantique, 56000 Vannes, France; (A.L.G.); (J.J.)
| | - Jérémy Jouan
- Department of Radiology, Centre Hospitalier Bretagne Atlantique, 56000 Vannes, France; (A.L.G.); (J.J.)
| | | | - Antoine Larralde
- Department of Radiology, CHU de Rennes, 35000 Rennes, France; (J.-F.H.); (A.L.)
| | - Damiano Cerasuolo
- Department of Biostatistics and Clinical Research, CHU de Caen, 14000 Caen, France
| | - Emmanuel Bergot
- Department of Pulmonology and Respiratory Disease, CHU de Caen, 14000 Caen, France;
| | - Audrey Fohlen
- Department of Radiology, CHU de Caen, 14000 Caen, France; (A.F.); (J.-P.P.)
- Normandy University, UNICAEN, CEA, CNRS, ISTCT-CERVOxy, 14000 Caen, France
| | - Jean-Pierre Pelage
- Department of Radiology, CHU de Caen, 14000 Caen, France; (A.F.); (J.-P.P.)
- Normandy University, UNICAEN, CEA, CNRS, ISTCT-CERVOxy, 14000 Caen, France
| |
Collapse
|
2
|
Endovascular embolization for Rasmussen's aneurysm with massive hemoptysis: 3 case reports and literature review. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
3
|
Chen S, Zhang Y, Huang Z, Ma S, Chen G, Zhu D, Liu J, Tang C, Zhang H, Zhao Z. A novel angiographic classification of pseudoaneurysms of the pulmonary chronic inflammatory cavity based on selective angiograms and therapeutic implications. J Thorac Dis 2022; 14:1784-1793. [PMID: 35813718 PMCID: PMC9264097 DOI: 10.21037/jtd-21-1485] [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: 09/10/2021] [Accepted: 05/05/2022] [Indexed: 11/12/2022]
Abstract
Background Hemoptysis is a common clinical symptom. In the chronic tuberculosis cavity and chronic necrotizing pneumonia cavity, pseudoaneurysms (Pas) easily form and are prone to massive hemoptysis and repeated hemoptysis and can even endanger patient's life. However, it remains to be further analyzed whether Pas of the pulmonary chronic inflammatory cavity selectively affect the peripheral pulmonary branches. This study is based on selective angiography to classify peripheral pulmonary arterial Pas (PAPs) of the pulmonary chronic inflammatory cavity and to determine treatment options for PAPs, thereby guiding individualized clinical treatment. Methods Angiographic data of 392 noncancer patients undergoing hemoptysis were retrospectively analyzed. All of the patients underwent pulmonary and selective pulmonary angiography and bronchial and nonbronchial systemic collateral arterial angiography. A total of 9 patients had Pas of the pulmonary chronic inflammatory cavity, and a pseudoaneurysm systemic artery collateral (Pasac), inflow and outflow sections of the parent vessels, and direction of blood flow in the parent vessels were clearly observed with digital subtraction angiography (DSA) and/or C-arm cone-beam flat-panel detector computed tomography angiography (CBCTA). Patients with underlying disease had pulmonary tuberculosis (n=8) or lung abscess (n=1). The angiographic types of Pas were analyzed. Results Eight patients with chronic pulmonary tuberculosis and 1 patient with a necrotizing pneumonia cavity in the convalescent period were included in the study. Pas of the pulmonary chronic inflammatory cavity presented the following types: (I) pulmonary artery pseudoaneurysm (PAPa) (n=2 cases); (II) body arterial Pa (n=3 cases); and (III) systemic-pulmonary anastomosis Pa. Each type could be divided into two subtypes (n=4 cases). In nine cases, embolization and hemostasis were technically and clinically successful. Conclusions Pas of the pulmonary chronic inflammatory cavity are diverse (especially in cases of pulmonary tuberculosis). Angiographic typing plays a guiding role in the selection of an embolization strategy.
Collapse
Affiliation(s)
- Shengli Chen
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Yuan Zhang
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Zicheng Huang
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Shuoyi Ma
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Guodong Chen
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Dongliang Zhu
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Jianhua Liu
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Chunmei Tang
- Department of Pulmonary Medicine, Guangzhou Chest Hospital, Guangzhou, China
| | - Hui Zhang
- Department of Radiology, Guangzhou Chest Hospital, Guangzhou, China
| | - Zhuxiang Zhao
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| |
Collapse
|
4
|
Smith ZT, Haines J, Calkins E, Fox J, Scriver G, Morris CS. Transcatheter coil embolization of a complex pulmonary artery pseudoaneurysm with thyrocervical trunk-pulmonary arterial fistulization in a patient with cystic fibrosis and massive hemoptysis. Radiol Case Rep 2022; 17:1836-1842. [PMID: 35401900 PMCID: PMC8990057 DOI: 10.1016/j.radcr.2022.03.024] [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] [Received: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022] Open
Abstract
Pulmonary artery pseudoaneurysm (PAP) is a rare cause of life-threatening hemoptysis and tends to develop in the setting of infection, neoplasm, or trauma. Successful endovascular coil embolization has demonstrated effectiveness in treating PAPs and is now the treatment of choice for these patients. Vascular supply to PAPs is highly variable and often requires embolization of both the systemic and pulmonary feeding vessels. This is a case report of a successful transcatheter coil embolization of a complex PAP with a thyrocervical trunk-pulmonary arterial fistula in a patient with massive hemoptysis in the setting of advanced cystic fibrosis.
Collapse
|
5
|
Somboonviboon D, Wattanathum A. Pulmonary pseudoaneurysm presented as a lung nodule after recovering from
Covid
‐19 pneumonia. Respirol Case Rep 2022; 10:e0963. [PMID: 35592269 PMCID: PMC9095993 DOI: 10.1002/rcr2.963] [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] [Received: 11/18/2021] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
Pulmonary pseudoaneurysms (PAPs) are an uncommon complication of severe acute respiratory syndrome coronavirus 2 infection, although they are a potentially life‐threatening condition. We present this interesting condition of severe coronavirus disease 2019 (Covid‐19) pneumonia. The patient presented with abnormal lung nodule and developed massive haemoptysis after recovering from Covid‐19 pneumonia. PAP was diagnosed by computed tomography angiography. Endovascular embolization was performed and the bleeding was stopped.
Collapse
Affiliation(s)
- Dujrath Somboonviboon
- Pulmonary and Critical Care Division, Department of Medicine Phramongkutklao Hospital Bangkok Thailand
| | - Anan Wattanathum
- Pulmonary and Critical Care Division, Department of Medicine Phramongkutklao Hospital Bangkok Thailand
| |
Collapse
|
6
|
Gupta N, Chattopadhyay A, Nyayadhish RK, Saikia D. Necrotizing MRSA pneumonia with mycotic pulmonary artery pseudo: Aneurysm in an infant. Pediatr Pulmonol 2022; 57:772-774. [PMID: 34936233 DOI: 10.1002/ppul.25800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 11/13/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Natasha Gupta
- Department of Radiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | | | | | - Diganta Saikia
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| |
Collapse
|
7
|
Tanaka H, Uraki J, Tanigawa M, Nakanishi Y, Toyoshima H, Sakabe S. An unusual case of hemoptysis: Pulmonary artery pseudoaneurysm secondary to a lung abscess. Respir Med Case Rep 2021; 34:101508. [PMID: 34540580 PMCID: PMC8437821 DOI: 10.1016/j.rmcr.2021.101508] [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: 03/26/2021] [Revised: 06/24/2021] [Accepted: 09/01/2021] [Indexed: 12/02/2022] Open
Abstract
Massive hemoptysis may originate from injured pulmonary arteries, such as from pulmonary artery pseudoaneurysms (PAPs). A 93-year-old man, diagnosed with pneumonia, was hospitalized; he later developed a lung abscess (controlled with intravenous antibiotics). On post-hospitalization day 29, he suddenly developed hemoptysis. Multi-detector computed tomography angiography (MDCTA) showed an enhanced nodule, diagnosed as a PAP, inside the lung abscess. The hemoptysis resolved, without recurrence, following transcatheter arterial embolization (TAE) of the PAP and its feeding arteries. PAPs should be considered in patients with lung abscesses and delayed massive hemoptysis. In these patients, MDCTA and TAE are effective diagnostic and treatment modalities. Massive hemoptysis can originate from pulmonary artery pseudoaneurysms (PAPs). PAPs should be considered in patients with delayed hemoptysis and lung abscesses. Multi-detector computed tomography angiography can identify origin of hemoptysis. It is useful for diagnosing and treating PAPs secondary to lung abscesses. Transcatheter arterial embolization can treat PAPs secondary to lung abscesses.
Collapse
Affiliation(s)
- Hiroyuki Tanaka
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, 471-2, Funae, Ise, Mie, 516-8512, Japan
| | - Junji Uraki
- Department of Radiology, Japanese Red Cross Ise Hospital, 471-2, Funae, Ise, Mie, 516-8512, Japan
| | - Motoaki Tanigawa
- Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, 471-2, Funae, Ise, Mie, 516-8512, Japan
| | - Yuki Nakanishi
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, 471-2, Funae, Ise, Mie, 516-8512, Japan
| | - Hirokazu Toyoshima
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, 471-2, Funae, Ise, Mie, 516-8512, Japan
| | - Shigetoshi Sakabe
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, 471-2, Funae, Ise, Mie, 516-8512, Japan
| |
Collapse
|
8
|
Marquis KM, Raptis CA, Rajput MZ, Steinbrecher KL, Henry TS, Rossi SE, Picus DD, Bhalla S. CT for Evaluation of Hemoptysis. Radiographics 2021; 41:742-761. [PMID: 33939537 DOI: 10.1148/rg.2021200150] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hemoptysis, which is defined as expectoration of blood from the alveoli or airways of the lower respiratory tract, is an alarming clinical symptom with an extensive differential diagnosis. CT has emerged as an important noninvasive tool in the evaluation of patients with hemoptysis, and the authors present a systematic but flexible approach to CT interpretation. The first step in this approach involves identifying findings of parenchymal and airway hemorrhage. The second step is aimed at determining the mechanism of hemoptysis and whether a specific vascular supply can be implicated. Hemoptysis can have primary vascular and secondary vascular causes. Primary vascular mechanisms include chronic systemic vascular hypertrophy, focally damaged vessels, a dysplastic lung parenchyma with systemic arterial supply, arteriovenous malformations and fistulas, and bleeding at the capillary level. Evaluating vascular mechanisms of hemoptysis at CT also entails determining if a specific vascular source can be implicated. Although the bronchial arteries are responsible for most cases of hemoptysis, nonbronchial systemic arteries and the pulmonary arteries are important potential sources of hemoptysis that must be recognized. Secondary vascular mechanisms of hemoptysis include processes that directly destroy the lung parenchyma and processes that directly invade the airway. Understanding and employing this approach allow the diagnostic radiologist to interpret CT examinations accurately in patients with hemoptysis and provide information that is best suited to directing subsequent treatment. ©RSNA, 2021.
Collapse
Affiliation(s)
- Kaitlin M Marquis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Constantine A Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - M Zak Rajput
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Kacie L Steinbrecher
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Travis S Henry
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Santiago E Rossi
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Daniel D Picus
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| |
Collapse
|
9
|
Khurram R, Karia P, Naidu V, Quddus A, Woo WL, Davies N. Pulmonary artery pseudoaneurysm secondary to COVID-19 treated with endovascular embolisation. Eur J Radiol Open 2021; 8:100346. [PMID: 33898655 PMCID: PMC8053241 DOI: 10.1016/j.ejro.2021.100346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 11/22/2022] Open
Abstract
Pulmonary artery pseudoaneurysms are uncommon and can cause severe, life-threatening haemoptysis. We present a case of a 74-year-old gentleman who was being treated for COVID-19 pneumonitis and a concomitant segmental pulmonary artery thrombus with conventional treatment and anticoagulation. The patient developed significant haemoptysis during admission. A repeat computed tomography pulmonary angiogram revealed an 8 mm left upper lobe pulmonary artery pseudoaneurysm. Anticoagulation was withheld and the pseudoaneurysm was successfully treated with endovascular embolisation with an Amplatzer® IV plug, leading to resolution of the haemoptysis. To our knowledge this is the first case of a pulmonary artery pseudoaneurysm secondary to COVID-19.
Collapse
Affiliation(s)
- Ruhaid Khurram
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London, NW3 2QG, United Kingdom
| | - Priyesh Karia
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London, NW3 2QG, United Kingdom
| | - Vishnu Naidu
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London, NW3 2QG, United Kingdom
| | - Ayyaz Quddus
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London, NW3 2QG, United Kingdom
| | - Wen Ling Woo
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London, NW3 2QG, United Kingdom
| | - Neil Davies
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London, NW3 2QG, United Kingdom
| |
Collapse
|
10
|
Pulmonary artery pseudoaneurysms: endovascular management after adequate imaging diagnosis. Eur Radiol 2021; 31:6480-6488. [PMID: 33713173 DOI: 10.1007/s00330-021-07819-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/01/2021] [Accepted: 02/19/2021] [Indexed: 10/21/2022]
Abstract
Pulmonary artery pseudoaneurysms (PAPs) are rare serious vascular abnormalities mostly due to infections and trauma, although other conditions such as vasculitis, neoplasms, or inflammatory lung diseases can also predispose to this entity. Endovascular techniques such as embolization or covered stent placement have mostly substituted surgical approaches, for their lower invasiveness and greater security, mainly in patients with life-threatening hemoptysis. The purpose of this manuscript is to describe the imaging findings of pulmonary artery pseudoaneurysms and their endovascular management including tips to help interventional radiologists. PAP should be diagnosed as accurately and early as possible in order to prompt endovascular management of further life-threatening hemoptysis. KEY POINTS: • Pulmonary artery pseudoaneurysms (PAPs) are rare serious vascular abnormalities that may represent a life-threatening condition, mainly due to Staphylococcus, Streptococcus, or Mycobacterium tuberculosis. • Radiologists should know the imaging findings of PAP in order to make an accurate and early diagnosis to prompt endovascular management of further life-threatening hemoptysis.
Collapse
|
11
|
Fukuda Y, Homma T, Uno T, Murata Y, Suzuki S, Shiozawa E, Takimoto M, Sagara H. Fatal rupture of pulmonary artery pseudoaneurysm after thoracic radiation therapy against lung squamous cell carcinoma: A case report and literature review. Clin Case Rep 2021; 9:737-741. [PMID: 33598236 PMCID: PMC7869342 DOI: 10.1002/ccr3.3647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/14/2020] [Accepted: 11/24/2020] [Indexed: 01/01/2023] Open
Abstract
Pulmonary artery pseudoaneurysm is a rare but fatal condition. It has been associated with lung cancer, abscesses, and radiation therapy. Identification in patients with hemoptysis is critical, and timely interventional therapy is warranted.
Collapse
Affiliation(s)
- Yosuke Fukuda
- Department of MedicineDivision of Respiratory Medicine and AllergologyShowa University School of MedicineTokyoJapan
| | - Tetsuya Homma
- Department of MedicineDivision of Respiratory Medicine and AllergologyShowa University School of MedicineTokyoJapan
| | - Tomoki Uno
- Department of MedicineDivision of Respiratory Medicine and AllergologyShowa University School of MedicineTokyoJapan
| | - Yasunori Murata
- Department of MedicineDivision of Respiratory Medicine and AllergologyShowa University School of MedicineTokyoJapan
| | - Shintaro Suzuki
- Department of MedicineDivision of Respiratory Medicine and AllergologyShowa University School of MedicineTokyoJapan
| | - Eisuke Shiozawa
- Department of PathologyShowa University School of MedicineTokyoJapan
| | - Masafumi Takimoto
- Department of PathologyShowa University School of MedicineTokyoJapan
| | - Hironori Sagara
- Department of MedicineDivision of Respiratory Medicine and AllergologyShowa University School of MedicineTokyoJapan
| |
Collapse
|
12
|
Percutaneous transthoracic embolisation for massive haemoptysis secondary to peripheral pulmonary artery pseudoaneurysms. Eur Radiol 2020; 31:2183-2190. [PMID: 33011878 DOI: 10.1007/s00330-020-07348-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/19/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Pulmonary artery pseudoaneurysms (PAPs) are rare, but important and treatable cause of massive haemoptysis. Minimal data exists on their interventional radiology management due to their rarity, especially direct percutaneous injection. Here, we report our experience of direct percutaneous management of such pseudoaneurysms. METHODS Data of patients presenting to our department from January 2014 to November 2019 was retrospectively analysed, who presented with massive haemoptysis, and CT angiography positive for pulmonary artery pseudoaneurysms. Only patients treated with direct percutaneous intervention were included. Twelve patients who were managed endovascularly were excluded from the study. Observations were tabulated under age, sex, underlying pathology, lobe involved, number and size of the pseudoaneurysm, imaging guidance and embolising agent. Technical and clinical success and complications were then analysed. RESULTS Twenty-nine pseudoaneurysms were treated in 27 patients with a mean age of 41.4 years. The most common underlying aetiology was tuberculosis (85.1%), with the most common location being bilateral upper lobes (31% each). CT guidance was the most frequently used imaging guidance (26/29). N-butyl cyanoacrylate (NBCA) glue mixture was used in 79.3% and reconstituted thrombin in the remaining 20.7% pseudoaneurysms. Complete technical and clinical success rates were 93.1% and 88.9% respectively. No major complications were seen except for development of significant pneumothorax in one patient. CONCLUSION Pulmonary pseudoaneurysms are rare but fatal cause for massive haemoptysis. Interventional radiology management via direct percutaneous embolisation is a safe and minimally invasive treatment measure in selective patients, with successful outcomes and minimal complication and recurrence rates. KEY POINTS • Pulmonary artery pseudoaneurysms are rare but important and treatable cause of massive haemoptysis. • This study shows the advantages of percutaneous management of these pseudoaneurysms as an alternate to endovascular embolisation, in case endovascular embolisation is not feasible or practical. • It is a safe and minimally invasive treatment, with technical success of 93.1% and clinical success of 88.9% in this study.
Collapse
|
13
|
Aspergillus Mimicking a Rasmussen Aneurysm in an Immunocompromised Setting Causing Massive Hemoptysis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Kord A, James E, Herren J, Gaba RC, Lokken RP. Esophagopulmonary fistula causing pulmonary arterial pseudoaneurysms and massive hemoptysis. Radiol Case Rep 2020; 15:914-920. [PMID: 32382378 PMCID: PMC7201158 DOI: 10.1016/j.radcr.2020.04.032] [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] [Received: 04/02/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
An esophagopulmonary fistula (EPF) may occur in patients with esophageal carcinoma and result in pulmonary abscess formation. Lung abscesses may in turn cause pulmonary artery (PA) pseudoaneurysms and life-threatening hemoptysis. We report a 59-year-old man with past medical history of metastatic distal esophageal adenocarcinoma who presented with fever, cough, and massive hemoptysis. Imaging evaluation demonstrated an EPF, associated lung abscess, and PA pseudoaneurysms. The presented case illustrates that embolization of PA pseudoaneurysms to prevent bleeding, and endoscopic esophageal covered stent graft placement to divert esophageal contents from the abscess, may facilitate a favorable outcome.
Collapse
|
15
|
Olsen KM, Manouchehr-Pour S, Donnelly EF, Henry TS, Berry MF, Boiselle PM, Colletti PM, Harrison NE, Kuzniewski CT, Laroia AT, Maldonado F, Pinchot JW, Raptis CA, Shim K, Tong BC, Wu CC, Kanne JP. ACR Appropriateness Criteria® Hemoptysis. J Am Coll Radiol 2020; 17:S148-S159. [PMID: 32370959 DOI: 10.1016/j.jacr.2020.01.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/26/2022]
Abstract
Hemoptysis, the expectoration of blood, ranges in severity from nonmassive to massive. This publication reviews the literature on the imaging and treatment of hemoptysis. Based on the literature, the imaging recommendations for massive hemoptysis are both a chest radiograph and CT with contrast or CTA with contrast. Bronchial artery embolization is also recommended in the majority of cases. In nonmassive hemoptysis, both a chest radiograph and CT with contrast or CTA with contrast is recommended. Bronchial artery embolization is becoming more commonly utilized, typically in the setting of failed medical therapy. Recurrent hemoptysis, defined as hemoptysis that recurs following initially successful cessation of hemoptysis, is best reassessed with a chest radiograph and either CT with contrast or CTA with contrast. Bronchial artery embolization is increasingly becoming the treatment of choice in recurrent hemoptysis, with the exception of infectious causes such as in cystic fibrosis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | | | - Edwin F Donnelly
- Panel Chair, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Travis S Henry
- Panel Vice-Chair, University of California San Francisco, San Francisco, California
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Phillip M Boiselle
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | | | - Nicholas E Harrison
- Beaumont Health System, Royal Oak, Michigan; American College of Emergency Physicians
| | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | | | - Kyungran Shim
- John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois; American College of Physicians
| | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | - Carol C Wu
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
16
|
Brief review: Pulmonary artery aneurysms and pseudoaneurysms. Int J Cardiovasc Imaging 2019; 35:1357-1364. [DOI: 10.1007/s10554-019-01547-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 01/24/2019] [Indexed: 11/27/2022]
|
17
|
Transcatheter Proximal Coil Blocking with n-Butyl-2-Cyanoacrylate Injection via the Pulmonary Artery Alone for Rasmussen's Aneurysm. Case Rep Radiol 2019; 2019:1725238. [PMID: 31139487 PMCID: PMC6500601 DOI: 10.1155/2019/1725238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/27/2019] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
Rasmussen's aneurysm is a peripheral pulmonary artery pseudoaneurysm (PAP) within a tuberculosis cavity. Because it can be perfused from the bronchial and pulmonary arterial circulations, combined embolization via the bronchial and pulmonary arteries is sometimes required. Herein, we present case of a 51-year-old man with Rasmussen's aneurysm that was successfully treated by proximal coil blocking with n-butyl-2-cyanoacrylate (NBCA) injection via the pulmonary artery alone. With proximal coil blocking, a sufficient amount of NBCA could be injected without unintended reflux of the NBCA cast to the proximal pulmonary artery. To our knowledge, there has been no report that attempted NBCA injection under proximal coil blocking for Rasmussen's aneurysm. Our treatment approach may be safe and effective for infectious lung disease-related PAP, which has to be treated from the pulmonary artery side.
Collapse
|
18
|
Single-phase Split-bolus Dual Energy Computed Tomography Angiography for Evaluation of Hemoptysis: A Novel Application. J Thorac Imaging 2018; 33:366-376. [PMID: 29979241 DOI: 10.1097/rti.0000000000000337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to assess feasibility and overall utility of single-phase split-bolus dual energy computed tomography (DECT) angiography (DECTA) for evaluation of hemoptysis, and to establish an injection protocol for evaluation of hemoptysis, by comparing 2 contrast injection protocols. MATERIALS AND METHODS Using dual-source (80 and 140 kV), 2×128-slice equipment, DECTA was performed using 400 mg iodine/mL, 50 to 80 mL iodinated contrast in 257 patients (189 male individuals, 68 female individuals, age range: 15 to 76 y) presenting with hemoptysis. Initially, 50 patients were randomized into 2 groups for 2 different injection protocols (A and B). Images were assessed quantitative and qualitatively. Later, 207 patients were randomized using protocol B, which was technically simpler, and single-CT acquisition, for simultaneous opacification of systemic and pulmonary vessels. RESULTS Injection protocol A resulted in higher vessel attenuation, both in the aorta and in the pulmonary artery and its segmental branches; however, the difference was not statistically significant. No significant difference was noted in signal-to-noise ratio, contrast-to-noise ratio, as well as subjective image quality parameters. Overall optimal opacification of both systemic and pulmonary arteries was achieved in 247/257 patients. A total of 308 abnormal bronchial arteries were noted. A total of 392 nonbronchial systemic arteries were noted, the majority arising from posterior intercostals and subclavian artery branches. The pulmonary source of hemoptysis was identified in 9 patients (3 pulmonary thromboembolisms, 5 pulmonary artery pseudoaneurysms, and 1 pulmonary venous ectasia). CONCLUSION Combined DECTA is a novel technique that enables simultaneous evaluation of both systemic and pulmonary vascular cause of hemoptysis in a single acquisition with small contrast dose. Both injection protocols "A" and "B" were equally efficacious in simultaneous opacification of both the aorta and pulmonary arteries. To the best of our knowledge, such a protocol has never been described for hemoptysis evaluation.
Collapse
|
19
|
Marcelin C, Soussan J, Desmots F, Gaubert JY, Vidal V, Bartoli JM, Izaaryene J. Outcomes of Pulmonary Artery Embolization and Stent Graft Placement for the Treatment of Hemoptysis Caused by Lung Tumors. J Vasc Interv Radiol 2018; 29:975-980. [DOI: 10.1016/j.jvir.2018.01.773] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 11/28/2022] Open
|
20
|
Pulmonary Artery Pseudoaneurysm: A Rare Cause of Fatal Massive Hemoptysis. Case Rep Pulmonol 2018; 2018:8251967. [PMID: 29850353 PMCID: PMC5937510 DOI: 10.1155/2018/8251967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/15/2018] [Indexed: 11/18/2022] Open
Abstract
Pulmonary artery pseudoaneurysm (PAPA), an uncommon complication of pyogenic bacterial and fungal infections and related septic emboli, is associated with high mortality. The pulmonary artery (PA) lacks an adventitial wall; therefore, repeated endovascular seeding of the PA with septic emboli creates saccular dilations that are more likely to rupture than systemic arterial aneurysms. The most common clinical presentation of PAPA is massive hemoptysis and resultant worsening hypoxemia. Computed tomography angiography is the preferred diagnostic modality for PAPA; typical imaging patterns include focal outpouchings of contrast adjacent to a branch of the PA following the same contrast density as the PA in all phases of the study. In mycotic PAPAs, multiple synchronous lesions are often seen in segmental and subsegmental PAs due to ongoing embolic phenomena. The recommended approach for a mycotic PAPA is prolonged antimicrobial therapy; for massive hemoptysis, endovascular treatment (e.g., coil embolization, stenting, or embolization of the feeding vessel) is preferred. PAPA resection and lobectomy are a last resort, generally reserved for patients with uncontrolled hemoptysis or pleural hemorrhage. We present a case of a 28-year-old woman with necrotizing pneumonia from intravenous drug use who ultimately died from massive hemoptysis and shock after a ruptured PAPA.
Collapse
|
21
|
Hamada S, Nakano A, Tsukino M. Gran absceso pulmonar con seudoaneurisma de la arteria pulmonar. Arch Bronconeumol 2017; 53:454-455. [DOI: 10.1016/j.arbres.2016.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
|
22
|
Guillaume B, Vendrell A, Stefanovic X, Thony F, Ferretti GR. Acquired pulmonary artery pseudoaneurysms: a pictorial review. Br J Radiol 2017; 90:20160783. [PMID: 28337922 DOI: 10.1259/bjr.20160783] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pulmonary artery pseudoaneurysms (PAPs) are uncommon but potentially lethal. They may be incidentally discovered on imaging, or following massive haemoptysis if they rupture, with high risk of mortality. The most frequent causes of PAP are trauma and infectious disease. Vasculitis, in particular Behçet's disease, neoplasm, congenital disease and pulmonary hypertension are rarer causes of PAP. A PAP can be suspected from chest X-ray and contrast CT, but requires confirmation by CT angiography. Arteriography is no longer performed for diagnostic purposes, but can be useful in preparing endovascular occlusion of the PAP. In rare cases, surgery is necessary. The aim of this pictorial review was to illustrate the most common causes of acquired PAPs.
Collapse
Affiliation(s)
- Benedicte Guillaume
- 1 Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire A Michallon, Grenoble, France.,2 Université Grenoble Alpes, Grenoble, France
| | - Anne Vendrell
- 1 Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire A Michallon, Grenoble, France.,2 Université Grenoble Alpes, Grenoble, France
| | - Xavier Stefanovic
- 3 Service de radiologie, Centre Hospitalier Universitaire de Nimes, Nimes, France
| | - Frederic Thony
- 1 Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire A Michallon, Grenoble, France.,2 Université Grenoble Alpes, Grenoble, France
| | - Gilbert R Ferretti
- 1 Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire A Michallon, Grenoble, France.,2 Université Grenoble Alpes, Grenoble, France
| |
Collapse
|
23
|
Mak SM, Strickland N, Gopalan D. Complications of pulmonary hypertension: a pictorial review. Br J Radiol 2016; 90:20160745. [PMID: 27925469 DOI: 10.1259/bjr.20160745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pulmonary hypertension (PH) is a rare disease with a significant morbidity and mortality if untreated. The disease has a multifactorial aetiology and is often associated with insidious onset of signs and symptoms. Multimodality imaging is often required for establishing the diagnosis, evaluating the underlying haemodynamic compromise and follow-up after institution of therapy. The range of potential complications associated with PH vary widely. We aimed to summarize the imaging findings of complications that the radiologist should be familiar with.
Collapse
Affiliation(s)
- Sze M Mak
- Radiology Department, Hammersmith Hospital, London, UK
| | | | - Deepa Gopalan
- Radiology Department, Hammersmith Hospital, London, UK
| |
Collapse
|
24
|
Tanahashi Y, Kondo H, Osawa M, Yamamoto T, Yamaguchi M, Furui S. Transcatheter embolization of a Rasmussen aneurysm via pulmonary artery with n-butyl cyanoacrylate and iodized oil mixture injection with balloon occlusion. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2016. [DOI: 10.1016/j.jvscit.2016.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
Abstract
OBJECTIVE The purpose of this study was to analyze the clinical and CT features of pulmonary artery pseudoaneurysms (PAPs). MATERIALS AND METHODS A database search of chest CT examinations performed from January 1, 2000 to December 31, 2014 identified 24 patients with findings consistent with PAPs. A CT finding consistent with a PAP was defined as a focal saccular outpouching of a pulmonary artery. Medical records were reviewed to determine clinical presentations, treatments, and outcomes. CT scans were reviewed by two board-certified fellowship-trained chest radiologists. RESULTS A total of 35 PAPs were identified in 24 patients. Hemoptysis and shortness of breath were the most common presenting symptoms. The most commonly identified causes of PAPs were infection (33%), neoplasms (13%), and trauma (17%). Of the 35 PAPs, 29 (83%) were located in segmental or subsegmental pulmonary arteries. A solitary PAP was identified in 20 (83%) patients, and multiple PAPs were identified in three patients with endocarditis and one patient with pulmonary metastases. Only three of 35 (9%) PAPs were associated with a ground-glass halo. Endovascular treatment was successfully performed in 12 patients, and only one patient had immediate recurrent hemoptysis after treatment. PAP was clinically suspected by the referring clinicians in only three patients. Sixteen of the 35 (46%) PAPs were not reported on the initial CT studies. CONCLUSION PAPs showed a strong predilection for the peripheral pulmonary arteries. Multiplicity of PAPs can be seen in the settings of endocarditis and pulmonary metastatic disease. Most PAPs were not associated with a ground-glass halo. PAPs can be lethal but were often not suspected clinically and were underreported by radiologists.
Collapse
|
26
|
del Barco O, Kim W, Moeslein F, Shet N. Ultrasound-Aided Diagnosis of Pulmonary Artery Pseudoaneurysm in a Pediatric Patient. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479315613942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pulmonary artery pseudoaneurysm (PAP) is an uncommon entity associated with high mortality if left untreated. PAPs are most often acquired secondary to trauma, inflammation, infection, or malignancy. The most common presentation is hemoptysis, but many patients are asymptomatic. Because of the increased risk of enlargement and rupture, timely diagnosis and intervention is necessary. Imaging plays an essential role not only in diagnosis of this entity but also in intervention. We describe a case using gray-scale and color Doppler imaging providing sonographically aided diagnosis and follow-up of a clinically silent PAP in a pediatric patient.
Collapse
Affiliation(s)
| | - Wendy Kim
- University of Maryland Medical Center, Baltimore, MD, USA
| | - Fred Moeslein
- University of Maryland Medical Center, Baltimore, MD, USA
| | - Narendra Shet
- University of Maryland Medical Center, Baltimore, MD, USA
| |
Collapse
|
27
|
Garg S, King G, Varadi G. Pseudoaneurysm of pulmonary artery: rare complication of systemic chemotherapy. Clin Case Rep 2015; 3:845-8. [PMID: 26509021 PMCID: PMC4614654 DOI: 10.1002/ccr3.363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/17/2015] [Accepted: 06/30/2015] [Indexed: 11/12/2022] Open
Abstract
Pulmonary artery pseudoaneurysm is an uncommon yet fatal clinical entity. Its presentation can mimic a number of common diseases and can be easily missed. As pseudoaneurysm is associated with a number of fatal complications, clinicians should be aware of imaging features which distinguishes pseudoaneurysms from its close differentials. Early recognition and treatment of pseudoaneurysm can prevent fatal outcomes including hemothorax, rupture, or death.
Collapse
Affiliation(s)
- Shivani Garg
- Department of Internal Medicine, Albert Einstein Medical Center Philadelphia, Pennsylvania
| | - Gentry King
- Department of Internal Medicine, Albert Einstein Medical Center Philadelphia, Pennsylvania
| | - Gabor Varadi
- Department of Hematology and Oncology, MOHA Cancer Center, Albert Einstein Medical Center Philadelphia, Pennsylvania
| |
Collapse
|
28
|
Tsukada J, Hasegawa I, Torikai H, Sayama K, Jinzaki M, Narimatsu Y. Interventional Therapeutic Strategy for Hemoptysis Originating from Infectious Pulmonary Artery Pseudoaneurysms. J Vasc Interv Radiol 2015; 26:1046-1051.e1. [DOI: 10.1016/j.jvir.2015.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/25/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022] Open
|
29
|
Takeuchi Y, Morishita H, Sato Y, Hamaguchi S, Sakamoto N, Tokue H, Yonemitsu T, Murakami K, Fujiwara H, Sofue K, Abe T, Higashihara H, Nakajima Y, Sato M. Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition. Jpn J Radiol 2014; 32:500-17. [PMID: 24889662 DOI: 10.1007/s11604-014-0328-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/29/2014] [Indexed: 01/01/2023]
Abstract
Cyanoacrylates are a group of fast-acting adhesives. They form low viscosity liquids in the monomer state and instantly polymerize to become adhesive upon contact with ionic substances. Since the 1950s, they have been used around the world for industrial and household purposes. N-butyl cyanoacrylate (NBCA) is a cyanoacrylate that is commonly used for medical care, and the closure of skin wounds with NBCA has been found to promote hemostasis. However, in Japan, the intravascular injection of NBCA is considered to be off-label use, except during the treatment of gastric varices under endoscopy. The use of NBCA in embolotherapy is considered when the target vessels cannot be cannulated superselectively, for vascular diseases that require long segments of the target vessel to be embolized, or for patients in a hypocoagulable state. NBCA-based embolotherapy can be used to treat vascular malformations, acute hemorrhaging, tumors, and venous disease. The complications associated with NBCA-based embolotherapy include tissue ischemia, hemorrhaging, systemic or local reactions, and catheter adhesion to blood vessels. NBCA is mixed with Lipiodol to make it radiopaque and to adjust its polymerization time. Since there are various technical aspects to performing NBCA-based embolotherapy safely, it should be carried out by, or with the assistance of, proficient interventional radiologists.
Collapse
Affiliation(s)
- Yoshito Takeuchi
- Department of Radiology, North Medical Center, Kyoto Prefectural University of Medicine, 481, Otokoyama, Yosanocho, Yosagun, Kyoto, 629-2261, Japan,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Garnett GM, Kimball S, Kon K, Woo RK. Pulmonary artery pseudoaneurysm after MRSA septicemia in a pediatric patient. J Pediatr Surg 2013; 48:E33-6. [PMID: 23701806 DOI: 10.1016/j.jpedsurg.2013.03.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/25/2013] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
Abstract
We document a previously unreported case of a pulmonary artery pseudoaneurysm (PAP) that developed in a pediatric patient initially presenting with Methicillin-resistant Staphylococcus aureus hip joint sepsis. This is the first reported case of PAP of infectious origin in a pediatric patient, and this case is unique as the evolution of the PAP was documented by computed tomography.
Collapse
Affiliation(s)
- Gwendolyn M Garnett
- Department of Surgery, University of Hawai'i, John A. Burns School of Medicine, Honolulu, HI 96826, USA
| | | | | | | |
Collapse
|
31
|
Morinaga Y, Yanagihara K, Gyotoku H, Oshima K, Izumikawa K, Yamasaki N, Kakeya H, Hayashi T, Fukuoka J, Nagayasu T, Kohno S. Pulmonary artery pseudoaneurysm caused by Streptococcus constellatus. Int J Infect Dis 2013; 17:e1064-6. [PMID: 24128874 DOI: 10.1016/j.ijid.2013.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 03/11/2013] [Accepted: 03/11/2013] [Indexed: 10/26/2022] Open
Abstract
We report a rare case of mycotic pulmonary artery pseudoaneurysm (PAP) secondary to a lung abscess due to Streptococcus constellatus. PAP was confirmed by the pathological findings of the pseudoaneurysm, the presence of bacteria, and the microbiological analysis. PAP is uncommon, but it is important to recognize this condition because PAP can lead to fatal hemoptysis.
Collapse
Affiliation(s)
- Yoshitomo Morinaga
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki 852-8501, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Restrepo CS, Carswell AP. Aneurysms and Pseudoaneurysms of the Pulmonary Vasculature. Semin Ultrasound CT MR 2012; 33:552-66. [DOI: 10.1053/j.sult.2012.04.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
33
|
Ramsey J, Amari M, Kantrow SP. Pulmonary vasculitis: clinical presentation, differential diagnosis, and management. Curr Rheumatol Rep 2011; 12:420-8. [PMID: 20882372 DOI: 10.1007/s11926-010-0136-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This review focuses on vasculitides with prominent pulmonary manifestations and discusses key contributions from the recent literature. Pulmonary vasculitis should be considered when clinical findings include alveolar hemorrhage, nodular and cavitary lung disease, airway stenosis, pulmonary artery aneurysms, or pulmonary artery stenosis. The differential diagnostic considerations for common clinical presentations of vasculitis in the lung are important, and several recent additions are discussed. Treatment for established pulmonary vasculitis is effective and has decreased the morbidity and mortality associated with these diseases while introducing an increased risk of infectious complications. Advances in immunosuppressive therapy have improved treatment of refractory disease and are likely to change initial treatment strategies in the future.
Collapse
Affiliation(s)
- Jennifer Ramsey
- Cleveland Clinic Main Campus, Mail Code A90, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | | | | |
Collapse
|
34
|
Portron Y, Lederlin M, Montaudon M, Corneloup O, Latrabe V, Barbot R, Laurent F. [Embolization of a Rasmussen's aneurysm complicating active tuberculosis]. JOURNAL DE RADIOLOGIE 2010; 91:911-914. [PMID: 20814381 DOI: 10.1016/s0221-0363(10)70135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
35
|
Impact of MDCT Angiography on the Management of Patients With Hemoptysis. AJR Am J Roentgenol 2010; 195:772-8. [DOI: 10.2214/ajr.09.4161] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
36
|
Shin S, Shin TB, Choi H, Choi JS, Kim YH, Kim CW, Jung GS, Kim Y. Peripheral Pulmonary Arterial Pseudoaneurysms: Therapeutic Implications of Endovascular Treatment and Angiographic Classifications. Radiology 2010; 256:656-64. [DOI: 10.1148/radiol.10091416] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
37
|
Ramakrishnan S, Kothari SS, Sharma S. Massive left pulmonary artery pseudoaneurysm in a young child. JACC Cardiovasc Interv 2010; 3:362-3. [PMID: 20298999 DOI: 10.1016/j.jcin.2009.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 11/18/2009] [Accepted: 12/13/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Sivasubramanian Ramakrishnan
- Departments of Cardiology and Cardioradiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | | | | |
Collapse
|
38
|
Lee WK, Mossop PJ, Little AF, Fitt GJ, Vrazas JI, Hoang JK, Hennessy OF. Infected (mycotic) aneurysms: spectrum of imaging appearances and management. Radiographics 2009; 28:1853-68. [PMID: 19001644 DOI: 10.1148/rg.287085054] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Infected aneurysms are uncommon. The aorta, peripheral arteries, cerebral arteries, and visceral arteries are involved in descending order of frequency. Staphylococcus and Streptococcus species are the most common causative pathogens. Early clinical diagnosis of infected aneurysms is challenging owing to their protean manifestations. Clinically apparent infected aneurysms are often at an advanced stage of development or are associated with complications, such as rupture. Nontreatment or delayed treatment of infected aneurysms often has a poor outcome, with high morbidity and mortality from fulminant sepsis or hemorrhage. Current state-of-the-art imaging modalities, such as multidetector computed tomography and magnetic resonance imaging, have replaced conventional angiography as minimally invasive techniques for detection of infected aneurysms in clinically suspected cases, as well as characterization of infected aneurysms and vascular mapping for treatment planning in confirmed cases. Doppler ultrasonography allows noninvasive assessment for infected aneurysms in the peripheral arteries. Imaging features of infected aneurysms include a lobulated vascular mass, an indistinct irregular arterial wall, perianeurysmal edema, and a perianeurysmal soft-tissue mass. Perianeurysmal gas, aneurysmal thrombosis, aneurysmal wall calcification, and disrupted arterial calcification at the site of the infected aneurysm are uncommon findings. Imaging-guided endovascular stent-graft repair and embolotherapy can be performed in select cases instead of open surgery. Familiarity with the imaging appearances of infected aneurysms should alert the radiologist to the diagnosis and permit timely treatment, which may include endovascular techniques.
Collapse
Affiliation(s)
- Wai-Kit Lee
- Department of Medical Imaging, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia.
| | | | | | | | | | | | | |
Collapse
|
39
|
Aetiology, diagnosis and management of infective causes of severe haemoptysis in intensive care units. Curr Opin Pulm Med 2008; 14:195-202. [PMID: 18427242 DOI: 10.1097/mcp.0b013e3282f79663] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE REVIEW Infective causes of severe haemoptysis have progressively shifted to causes related to chronic inflammatory lung diseases. Physicians should, however, recognize the most common of them, for example necrotizing parenchymal infections, tuberculosis and mycetoma. RECENT FINDINGS The recent increase in the incidence of a devastating Panton-Valentine leukocidin-associated staphylococcal pneumonia has reminded us of the crucial role of prompt diagnosis and management. General supportive care should be administered to prevent asphyxiation in addition to starting appropriate antibiotics as soon as possible. Once the bleeding has been controlled, the diagnostic strategy should integrate a detailed medical history, physical examination, Gram stain of the respiratory specimens and chest radiograph. Computed tomography scan has dramatically improved the diagnosis and the treatment of infective causes of severe haemoptysis by assessing the cause and mechanism(s) of haemoptysis. Although bronchial arteries are the major source of bleeding, nonbronchial systemic and pulmonary arteries' involvement should be feared, especially in haemoptysis related to tuberculosis and mycetoma. SUMMARY Endovascular therapy should be first attempted to control the bleeding and then elective surgery performed in case of localized lesion and adequate pulmonary function. Fibreoptic bronchoscopy with broncho-alveolar lavage remains the cornerstone of diagnosis in immunocompromised hosts with haemoptysis and in the rare cases of alveolar haemorrhage related to infectious diseases.
Collapse
|
40
|
Current World Literature. Curr Opin Pulm Med 2008; 14:266-73. [DOI: 10.1097/mcp.0b013e3282ff8c19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|