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Ferrante MS, Pisano C, Trombetti D, Asta L, Altieri C, Nardi P, Rivolo G. Pulmonary artery aneurysm: case report and experience of our center. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2024; 21:59-62. [PMID: 38693983 PMCID: PMC11059010 DOI: 10.5114/kitp.2024.138584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/18/2023] [Indexed: 05/03/2024]
Affiliation(s)
- Maria Sabrina Ferrante
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione), Palermo, Italy
| | - Calogera Pisano
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | - Daniele Trombetti
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | - Laura Asta
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | - Claudia Altieri
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | - Paolo Nardi
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | - Giovanni Rivolo
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
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2
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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.
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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
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3
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Ioakeimidis NS, Pepis P, Valasiadis D, Gkountelas G, Mitrousi K, Tossios P. Large main pulmonary artery aneurysm: Case report and brief review of the literature. Radiol Case Rep 2024; 19:319-325. [PMID: 38028315 PMCID: PMC10661587 DOI: 10.1016/j.radcr.2023.10.038] [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: 06/22/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Pulmonary artery aneurysms are a rare but often fatal clinical entity with an estimated incidence of 1 in 14,000 individuals in postmortem studies. They can be congenital or acquired. No specific guidelines regarding their optimal management, medical or surgical, currently exist and treatment is planned on a case-by-case basis since data regarding their clinical course and prognosis are limited. We present the case of a 77-year-old male patient who presented at the Emergency Department of our hospital with a complaint of exertional dyspnea and dull substernal pain over 1 week. Upon investigation, a main pulmonary artery true aneurysm measuring 61 mm on Computed Tomography was detected. The patient's history was remarkable for heavy smoking, arterial hypertension, dyslipidemia, known ascending aortic aneurysm, moderate COPD, and past tuberculosis. He was admitted to the Cardiology unit and treated as a case of decompensated heart failure with preserved ejection fraction. His symptoms improved with intravenous diuretics. A past chest MRI report, 7 years before his current event, described the main PA aneurysm measuring 51-52 mm. Regarding the main PA aneurysm, the heart team decided to follow a conservative approach with regular follow-up visits based on the patient's comorbidities, functional status, and slow growth rate of the PA aneurysm. Management of pulmonary artery aneurysms requires a heart-team approach in the context of the patient's underlying conditions and symptoms. More data are required in order to guide a treatment plan with an acceptable risk - benefit profile for each patient.
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Affiliation(s)
- Nikolaos S. Ioakeimidis
- Department of Cardiology, General Hospital of Florina “Eleni Th. Dimitriou”, Egnatias 9, Florina 53100, Greece
| | - Panagiotis Pepis
- Department of Cardiothoracic Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Dimitrios Valasiadis
- Department of Cardiology, General Hospital of Florina “Eleni Th. Dimitriou”, Egnatias 9, Florina 53100, Greece
| | - Georgios Gkountelas
- Department of Radiology, General Hospital of Florina “Eleni Th. Dimitriou”, Egnatias 9, Florina 53100, Greece
| | - Konstantina Mitrousi
- Department of Cardiac Imaging, Diagnostic Center “Ippokrateio - Ygeia Ptolemaidas”, Trapezountos 44, Ptolemaida 50200, Greece
| | - Paschalis Tossios
- Department of Cardiothoracic Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
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Munshi SK, Faraz F, Guerrero R. Surgical management of a giant pulmonary artery aneurysm in a patient with ischaemic heart disease - a case report. Cardiol Young 2023; 33:2657-2660. [PMID: 37706367 DOI: 10.1017/s1047951123003220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Association of Pulmonary Artery Aneurysm with Ischemic Heart Disease is uncommon, and its surgical management has been rarely described in the literature. Surgical intervention should be individualised according to the coexisting diseases and comorbidities to achieve optimal outcome. We report a case of a 76-year-old man with background history of coronary artery stenting due to ischaemic heart disease. The patient presented with features of coronary compression due to giant pulmonary artery aneurysm. He was operated with replacement of aneurysmal pulmonary trunk with 25 mm Hancock conduit.
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Affiliation(s)
- Sayar Kumar Munshi
- Department of Paediatric Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, UK
- Department of Adult Congenital Heart Disease (ACHD) Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Fahmi Faraz
- Department of Anaesthesia and Critical Care, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Rafael Guerrero
- Department of Paediatric Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, UK
- Department of Adult Congenital Heart Disease (ACHD) Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
- Faculty of Health and Life Science, School of Medicine, University of Liverpool, Liverpool, UK
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5
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Lorenz V, Gambacciani A, Guerrini S, Giuseppe MF, Gianfranco M, Mattesini A. Management of Giant Pulmonary Artery Aneurysm with Quadricuspid Valve Stenosis. Int J Angiol 2023; 32:312-315. [PMID: 37927838 PMCID: PMC10624532 DOI: 10.1055/s-0041-1732435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The pulmonary artery aneurysm (PAA) is a rare disease with no well-defined guidelines about the diagnostic criteria and its management. In fact, the indications for surgical treatment and the type of surgical approach are not clear. However, in case of giant PAAs with hypertension and pulmonary valve abnormalities, surgery should be considered as an effective and safe approach to prevent dissections or ruptures. In this report, we describe a successful case of surgical repair, using a Bioconduit with a pericardial patch to recreate the pulmonary artery bifurcation in a 72-year-old male with aneurysm of the pulmonary artery (max diameter: 72 mm), associated with quadricuspid pulmonary valve stenosis and pulmonary hypertension. The procedure was uncomplicated and the follow-up computed tomography scan at 4 months showed correct positioning of the graft with no sign of contrast leakage.
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Affiliation(s)
- Veronica Lorenz
- Unit of Cardiac Surgery, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Andrea Gambacciani
- Unit of Cardiac Surgery, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Susanna Guerrini
- Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Mazzei Francesco Giuseppe
- Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Montesi Gianfranco
- Unit of Cardiac Surgery, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Alessio Mattesini
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
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Xie J, Qin Y, Liu J, Liang W. A rare giant idiopathic pulmonary artery aneurysm and its management: A case report. Asian J Surg 2023; 46:4416-4417. [PMID: 37169685 DOI: 10.1016/j.asjsur.2023.04.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 05/13/2023] Open
Affiliation(s)
- Jianhua Xie
- Department of Cardiology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Yuxue Qin
- Department of Cardiology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Jianxiong Liu
- Department of Cardiology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Wei Liang
- Department of Cardiology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
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Association Between the Degree of Severity of Pulmonary Hypertension With the Presence of Pulmonary Artery Aneurysm: A Brief Updated Review for Clinicians. Curr Probl Cardiol 2023; 48:101645. [PMID: 36773948 DOI: 10.1016/j.cpcardiol.2023.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥20 mm Hg at rest as assessed by right cardiac catheterization. It has a median survival nowadays of 6 years, compared to 2.8 years in the 1980s. A pulmonary artery aneurysm (PAA) is the focal dilation of a blood vessel involving all 3 layers of the vessel wall; they have a diameter greater than 4 cm measured in the trunk of the pulmonary artery. PAAs can be classified into proximal (or central) and peripheral. The clinical manifestations of PAA are primarily nonspecific, and most patients remain undiagnosed, even those with large PAA, due to its silent course; however, clinical manifestations occur unless when there are complications such as bronchial or tracheal compression (leading to cough and dyspnea), dissection, or rupture (leading to hemoptysis). PAH is observed in 66% of patients with PAA. PA dissections are usually associated with PAH; 80% of dissections occur in the main pulmonary trunk. Although there is no clear guideline for the best treatment of PAA, surgery is indicated in patients with a pulmonary trunk aneurysm >5.5 cm. It has been observed that patients in the PAH group associated with congenital heart disease tend to develop PAA more commonly. Those with PAH associated with connective tissue disease have a smaller diameter of PA dilation. This report presents a comprehensive review of PAA, discussing critical aspects of the clinical and imaging diagnosis, hemodynamics, and treatment. A comprehensive updated literature review is included; we believe this article will interest cardiopulmonologists.
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Bhattad PB, Yukselen Z, Bhasin M, Roumia M. Left Pulmonary Artery Aneurysm: A Post-stenotic Pulmonary Aneurysm Related to Pulmonary Valve Stenosis. Cureus 2023; 15:e34836. [PMID: 36919075 PMCID: PMC10008472 DOI: 10.7759/cureus.34836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
Aneurysms of the pulmonary artery are uncommon vascular pathologies that are associated with congenital structural cardiac anomalies, pulmonary hypertension, vasculitis, neoplasm, iatrogenic, and infection. PAAs are commonly asymptomatic and accidentally diagnosed, however, if symptomatic, clinical features are generally non-specific and depend on the etiology of PAA. CT pulmonary angiography remains the gold standard imaging modality and other diagnostic imaging tests include transthoracic echocardiography and right heart catheterization. Definitive treatment of PAA is surgery, however, conservative management with close monitoring should be practiced in patients with poor surgical candidates or surgery is unlikely to improve survival. Here, we report a case of pulmonary artery aneurysm secondary to congenital pulmonary valve stenosis as well as a brief review of the literature regarding pulmonary artery aneurysms.
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Affiliation(s)
| | | | | | - Mazen Roumia
- Cardiovascular Medicine, Saint Vincent Hospital, UMass Chan Medical School, Worcester, USA
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Gallardo MEA. Giant Rasmussen's aneurysm in a 9-year-old boy: A case report. Radiol Case Rep 2022; 17:4168-4175. [PMID: 36105835 PMCID: PMC9464773 DOI: 10.1016/j.radcr.2022.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/02/2022] Open
Abstract
Rasmussen's aneurysm is a pseudoaneurysm caused by tuberculosis, when cavitation occurs adjacent to a pulmonary artery, which can be lethal. It is a rare complication usually affecting adults. This is a case of an 9-year-old boy initially admitted for pneumonia that developed hemoptysis during admission. Chest X-ray done after this episode showed development of a left hilar mass not present in the previous studies. A chest CT with contrast subsequently revealed a saccular aneurysm arising from the left lower lobe pulmonary artery adjacent to a cavity, a Rasmussen's aneurysm. The patient was treated conservatively with continuation of anti-TB medication and serial monitoring due to the size of the aneurysm being less than 6 cm and spontaneous resolution of the hemoptysis. This report stresses that a Rasmussen's aneurysm should always be in the differential diagnosis of a hilar mass in a patient with hemoptysis, regardless of the patient's age.
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Hussain B, Bhavsar D, Garyali S. Right ventricle outflow tract dilatation and pulmonary artery aneurysm, rare cardiac conditions. Radiol Case Rep 2022; 17:3655-3658. [PMID: 35936882 PMCID: PMC9352801 DOI: 10.1016/j.radcr.2022.07.003] [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: 05/08/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 11/03/2022] Open
Abstract
We describe a rare case of simultaneous idiopathic right ventricular outflow tract dilatation and idiopathic main pulmonary artery aneurysm. A 59-year-old male presented with complaints of exertional shortness of breath and a cardiac murmur since childhood. CT pulmonary angiogram showed main pulmonary artery dilatation with a diameter of 5.8 cm. Cardiac MRI revealed right ventricular outflow tract dilatation with a diameter of 5.4 cm and a main pulmonary artery aneurysm with a 5.6 cm diameter. Cardiothoracic surgery was consulted for surgical repair. Definitive management of right ventricular outflow tract dilatation and pulmonary artery aneurysms is challenging due to their infrequent diagnosis and lack of established guidelines. The treatment for central aneurysms is surgery which includes aneurysmectomy and right ventricular outflow tract repair or replacement.
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11
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An unusual case of chest pain: Giant pulmonary artery aneurysm secondary to patent ductus arteriosus. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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12
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Misdiagnosis of pulmonary artery aneurysm with eroding thrombus into the airways. A fatal case of suffocation. SCANDINAVIAN JOURNAL OF FORENSIC SCIENCE 2022. [DOI: 10.2478/sjfs-2021-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
We present a fatal case of hemoptysis following a thrombus-eroding pulmonary artery aneurysm into the left upper bronchus of a 79-year-old male with a history of multiple hospital contacts and examinations due to cough, hemoptysis, and reflux symptoms.
A postmortem computed tomography (CT) scan revealed a hyperdense, condensed area in the left lung in relation to the lung hilus. At autopsy, the forensic specialist discovered a large, organized thrombus in a pulmonary artery aneurysm. The thrombus was adherent to the pulmonary artery aneurysm wall with an underlying defect directly communicating to the left upper bronchus. The cause of death was asphyxia due to blood in the airways (i.e., suffocation).
The combination of pulmonary artery hypertension, previous pulmonary embolism, and hemoptysis should lead to a particularly thorough inspection of the lungs with a focus on the pulmonary circulation. This case report emphasizes the importance of early detection of patients at risk of pulmonary artery rupture and attentiveness when performing biopsies during bronchoscopy to prevent communication between the artery and the airway. The risk of rupturing an aneurysm should be taken into account when performing biopsies on excrescence intruding into the bronchus in patients with medical histories of pulmonary hypertension, cough, and sporadic hemoptysis.
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Salehi AM, Khansari N. Idiopathic Pulmonary Artery Aneurysm: A Case Report. Curr Cardiol Rev 2022; 18:50-52. [PMID: 36128732 PMCID: PMC9896424 DOI: 10.2174/1573403x18666220428122804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary artery aneurysm is a rare disorder that has been reported in less than 50 cases. This complication is often asymptomatic, while the first manifestation can be severe hemoptysis or death. CASE PRESENTATION A 36-year-old man presented to our institute with hemoptysis and fever. Dilated pulmonary artery trunk (5.5 cm) and the left pulmonary artery branch (6.90 cm) were discovered during a computed tomography angiogram scan in the patient's chest region. Therefore, the patient was diagnosed with a pulmonary artery aneurysm. According to the results of the tests requested for the patient, the cause of the patient's pulmonary artery aneurysm was not determined. Therefore, an idiopathic pulmonary artery aneurysm was proposed for the patient. CONCLUSION Idiopathic pulmonary artery aneurysm poses a double diagnostic and therapeutic problem. The rarity of the disease, and the absence of specific clinical signs make diagnosis difficult.
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Affiliation(s)
| | - Nakisa Khansari
- Address correspondence to this author at the Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran; E-mail:
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Furuyama K, Hirama N, Fukushima S, Inage M, Ota H, Sato K, Yamauchi K, Sato M, Igarashi A, Inoue S, Watanabe M. A case of pulmonary tuberculosis with hemoptysis from a peripheral pulmonary aneurysm. EXCLI JOURNAL 2021; 20:1482-1485. [PMID: 34803557 PMCID: PMC8600159 DOI: 10.17179/excli2021-4279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 11/10/2022]
Abstract
An 88-year-old woman visited our hospital for hemoptysis due to ruptured peripheral pulmonary aneurysm diagnosed by contrast computed tomography (CT) and angiography. Her bleeding was stopped by interventional radiology vascular embolization. She was diagnosed with pulmonary tuberculosis due to a positive acid-fast bacillus (AFB) smear test following admission and the positive polymerase chain reaction for tuberculosis, despite no obvious cavity lesions or scatter shadows on CT. The causes of hemoptysis due to pulmonary tuberculosis are known to be Rasmussen aneurysm, in which the blood vessel wall adjacent to the lung cavity is thinned to form an aneurysm, or bleeding from the bronchial artery. In this case, it was considered that the inflammation caused by pulmonary tuberculosis spread directly to the pulmonary artery and formed a pulmonary aneurysm without forming a cavity. Similar cases have been rarely reported. Clinicians need to consider pulmonary tuberculosis as the cause of pulmonary aneurysm, even without cavity lesions in the lungs. It is important to perform AFB examination to diagnose pulmonary tuberculosis.
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Affiliation(s)
- Kodai Furuyama
- Respiratory Medicine, Okitama Public General Hospital, 2000, Nishi-Otsuka, Kawanishi, Yamagata, Japan,Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
| | - Noriyuki Hirama
- Respiratory Medicine, Okitama Public General Hospital, 2000, Nishi-Otsuka, Kawanishi, Yamagata, Japan
| | - Shigeyuki Fukushima
- Respiratory Medicine, Okitama Public General Hospital, 2000, Nishi-Otsuka, Kawanishi, Yamagata, Japan
| | - Minoru Inage
- Respiratory Medicine, Okitama Public General Hospital, 2000, Nishi-Otsuka, Kawanishi, Yamagata, Japan
| | - Hiroki Ota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
| | - Kento Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
| | - Keiko Yamauchi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
| | - Masamichi Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
| | - Akira Igarashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
| | - Sumito Inoue
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan,*To whom correspondence should be addressed: Sumito Inoue, Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan; Tel: +81-23-628-5302, Fax: +81-23-628-5305, E-mail:
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
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Singh AB, Lin Y, Pal J. Operative intervention for a central pulmonary artery pseudoaneurysm. J Card Surg 2021; 36:4762-4765. [PMID: 34541714 DOI: 10.1111/jocs.15999] [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: 08/04/2021] [Revised: 08/31/2021] [Accepted: 09/11/2021] [Indexed: 11/29/2022]
Abstract
Pulmonary artery (PA) pseudoaneurysms are a rare but potentially lethal diagnosis. They can be further categorized by etiology or location and are typically successfully treated with endovascular therapies. However, they occasionally require operative intervention. Here, we present a case of a patient who presented with a central PA pseudoaneurysm on computed tomography scan with unclear etiology that was initially treated with conservative management. However, this was noted to have rapid enlargement on interval imaging necessitating urgent surgical intervention. The patient underwent a median sternotomy, anterior PA arteriotomy for exposure, exclusion of the posterior artery pseudoaneurysm with a bovine pericardial patch, and closure of the anterior arteriotomy with a bovine pericardial patch. The patient did well and was discharged on postoperative day 11 with repeat imaging showing resolution.
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Affiliation(s)
- Abhinav B Singh
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Yihan Lin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Jay Pal
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA
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16
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Ukemenam C, Muppaneni SP, De D, Lacasse A. Hugh-Stovin syndrome: the 'incomplete Behcet's disease'. A case study of a young adult with recurrent pulmonary embolism and pulmonary arterial aneurysms. J Community Hosp Intern Med Perspect 2021; 11:566-567. [PMID: 34211671 PMCID: PMC8221138 DOI: 10.1080/20009666.2020.1816273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Hugh-Stovin Syndrome (HSS) is characterized by recurrent thrombophlebitis and multiple pulmonary and/or bronchial artery aneurysms indistinguishable from the cardiovascular features seen in Behcet's disease (BD). Our case describes a 30-year-old male with recurrent pulmonary embolism and bilateral pulmonary aneurysms. Autoimmune, hypercoagulable, and infectious work up were negative. Elevated inflammatory markers and absence of the typical clinical findings seen in BD led to the diagnosis of Hugh-Stovin syndrome (HSS). Immunosuppression using steroids and azathioprine led to clinical response. Anticoagulation was continued based on risk/benefit ratio.
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Affiliation(s)
- Chinedu Ukemenam
- Department of Internal Medicine, SSM Saint Mary's Hospital, Saint Louis, Missouri, USA
| | | | - Debapriya De
- Department of Internal Medicine, SSM Saint Mary's Hospital, Saint Louis, Missouri, USA
| | - Alexandre Lacasse
- Department of Internal Medicine, SSM Saint Mary's Hospital, Saint Louis, Missouri, USA
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Raju SN, Pandey NN, Sharma A, Malhi AS, Deepti S, Kumar S. Pulmonary Arterial Dilatation: Imaging Evaluation Using Multidetector Computed Tomography. Indian J Radiol Imaging 2021; 31:409-420. [PMID: 34556926 PMCID: PMC8448224 DOI: 10.1055/s-0041-1734225] [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] [Indexed: 12/04/2022] Open
Abstract
Pulmonary artery dilatation comprises a heterogeneous group of disorders. Early diagnosis is important as the presentation may be incidental, chronic, or acute and life threatening depending upon the etiology. Cross-sectional imaging plays an important role, with CT pulmonary angiography being regarded as the first line investigation in the evaluation of pulmonary artery pathologies. Moreover, effects of pulmonary artery lesions on proximal and distal circulation can also be ascertained with the detection of associated conditions. Special attention should also be given to the left main coronary artery and the trachea-bronchial tree as they may be extrinsically compressed by the dilated pulmonary artery. In context of an appropriate clinical background, CT pulmonary angiography also helps in treatment planning, prognostication, and follow-up of these patients. This review mainly deals with imaging evaluation of the pulmonary arterial dilatations on CT with emphasis on the gamut of etiologies in the adult as well as pediatric populations.
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Affiliation(s)
- Sreenivasa Narayana Raju
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amarinder Singh Malhi
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharthan Deepti
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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18
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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.
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19
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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.
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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
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20
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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]
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21
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Hong Son PD, Tu VN, Uoc NH, Vo HL. Successful Aneurysmorrhaphy for a Giant Idiopathic Pulmonary Artery Aneurysm. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:275-278. [PMID: 32233900 DOI: 10.1177/1556984520911667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Idiopathic aneurysm of pulmonary artery is a rare disorder with unclear pathology and mechanism. The indications for its surgical treatment are not clear, especially in cases with normal pulmonary pressure. We report the case of a 64-year-old man with a giant idiopathic aneurysm of the pulmonary artery (max diameter 97.3 mm). The patient successfully underwent surgical treatment with the aneurysmorrhaphy in our Department of Cardiovascular and Thoracic Surgery. The patient was extubated successfully within 6 hours of the operation and discharged hospital after 10 days. In cases with giant aneurysm of the pulmonary artery, the aneurysmorrhaphy may be considered as a safe and feasible choice.
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Affiliation(s)
- Phung Duy Hong Son
- 435680 Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Vu Ngoc Tu
- 435680 Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Huu Uoc
- 435680 Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Hoang-Long Vo
- 106156 Vietnam Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
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22
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Qian Q, Subbian SK, Kofidis T. Total pulmonary artery replacement with an Avalus-Gelweave conduit in a patient with giant pulmonary artery aneurysm with pulmonary regurgitation. J Card Surg 2020; 35:1122-1124. [PMID: 32176359 DOI: 10.1111/jocs.14517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Pulmonary artery aneurysm is a rare disease. A 59-year-old Chinese female was diagnosed with idiopathic pulmonary aneurysm with pulmonary regurgitation. She had a past medical history of hemoptysis and systemic lupus erythematosus. METHODS She underwent a successful total pulmonary artery and valve replacement with an Avalus-Gelweave conduit. RESULTS The postoperative echocardiogram showed a 7 mm Hg peak gradient across the prosthetic valve. The patient's postoperative recovery was uncomplicated. CONCLUSIONS A bioprosthetic aortic valve can be used in a pulmonary position to achieve a good gradient and avoid long term anticoagulation therapy.
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Affiliation(s)
- Qi Qian
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Senthil Kumar Subbian
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Theo Kofidis
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre, Singapore, Singapore
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23
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Carino D, Mehta N, Fernández-Cisneros A, Pereda D. Surgical correction of a pulmonary artery aneurysm with severe pulmonary regurgitation with a valve-sparing technique. Interact Cardiovasc Thorac Surg 2020; 30:159-160. [PMID: 31539026 DOI: 10.1093/icvts/ivz224] [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: 05/26/2019] [Revised: 07/18/2019] [Accepted: 08/20/2019] [Indexed: 11/14/2022] Open
Abstract
Pulmonary artery aneurysms are rare but are associated with a significant risk of rupture and dissection. Moreover, pulmonary valve regurgitation and/or stenosis often coexist. In this study, we present a case of a pulmonary artery aneurysm with severe pulmonary regurgitation in a patient with pulmonary hypertension treated with aneurysm resection and pulmonary valve repair.
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Affiliation(s)
- Davide Carino
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Nikita Mehta
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Daniel Pereda
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
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24
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Campos LG, da Silva EC, Rangel AFR, de Souza MD, Musso C. Pulmonary artery aneurysm rupture. AUTOPSY AND CASE REPORTS 2019; 10:e2019131. [PMID: 32039062 PMCID: PMC6945309 DOI: 10.4322/acr.2019.131] [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: 06/17/2019] [Accepted: 10/07/2019] [Indexed: 11/28/2022] Open
Abstract
Pulmonary artery aneurysm is a disorder of varying etiology and should be diagnosed early for appropriate interventions. A 45-year-old man was hospitalized for chest pain, dyspnea, cough, chills, diarrhea, and vomiting, which had started 3 weeks before admission. Physical examination indicated a reduced vesicular murmur in the right hemithorax. A chest x-ray performed indicated a pneumothorax and pulmonary abscess in the right hemithorax. Thoracostomy released abundant purulent and fetid fluid. Direct examination of the pleural fluid using saline revealed structures similar to Trichomonas. Non-contrast chest computed tomography revealed right pneumothorax along with an irregular cavitation located at the pleuropulmonary interface of the posterior margin of the right lower lobe. A pleurostomy was performed. On the second postoperative day, the patient suffered a sudden major hemorrhage through the surgical wound and died on the way to the operating room. The autopsy revealed an abscess and ruptured aneurysm of the lower lobar artery in the lower right lung. Microscopic examination revealed extensive liquefactive necrosis associated with purulent inflammation and the presence of filamentous fungi and spores. This case can be characterized as a severe disorder that requires early diagnosis to achieve a good therapeutic response and to avoid fatal outcomes.
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Affiliation(s)
- Leticia Goulart Campos
- Federal University of Espírito Santo (UFES), Department of Pathology, Hospital Universitário Cassiano Antônio Moraes (HUCAM), Unidade de Anatomia Patológica. Vitória, ES, Brazil
| | - Eveline Cristina da Silva
- Federal University of Espírito Santo (UFES), Department of Pathology, Hospital Universitário Cassiano Antônio Moraes (HUCAM), Unidade de Anatomia Patológica. Vitória, ES, Brazil
| | - Ana Fernanda Ribeiro Rangel
- Federal University of Espírito Santo (UFES), Department of Pathology, Hospital Universitário Cassiano Antônio Moraes (HUCAM), Unidade de Anatomia Patológica. Vitória, ES, Brazil
| | - Marina Dias de Souza
- Federal University of Espírito Santo (UFES), Department of Pathology, Hospital Universitário Cassiano Antônio Moraes (HUCAM), Unidade de Anatomia Patológica. Vitória, ES, Brazil
| | - Carlos Musso
- Federal University of Espírito Santo (UFES), Department of Pathology, Hospital Universitário Cassiano Antônio Moraes (HUCAM), Unidade de Anatomia Patológica. Vitória, ES, Brazil
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25
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Martin BJ, Stephanie H, Muddassir R, Brent MI, Benjamin A, Peter B, Martin G. Successful embolization of an infected aneurysm of a subsegmental pulmonary artery in an infant with necrotizing MRSA pneumonia. Radiol Case Rep 2019; 14:1079-1083. [PMID: 31320966 PMCID: PMC6614110 DOI: 10.1016/j.radcr.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/08/2019] [Accepted: 06/17/2019] [Indexed: 11/20/2022] Open
Abstract
Para-infections aneurysms are a very rare complication but bear the risk of significant morbidity and mortality in case of rupture and hemorrhage. We present the youngest published case of a right-sided pulmonary artery pseudoaneurysm due to nonmultiresistant Staphylococcus aureus pneumonia in a 7-month old boy, complicated by 2 episodes of significant hemorrhage. Selective microvascular plug embolization of the feeding segmental pulmonary artery by interventional radiology and cardiology was successfully undertaken while having a cardiothoracic surgical team on stand-by. Follow-up ultrasounds showed no residual flow distal to the microvascular plug. The patient had complete clinical recovery 10 months after the initial presentation. Interventional radiology procedures are challenging in children due to limited availability of appropriately-sized equipment, low case numbers, and a limited body of literature.
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Affiliation(s)
- Burren Juerg Martin
- Paediatric Intensive Care Unit, Queensland Children's Hospital, 501 Stanley Street, South Brisbane QLD, Australia
- Child Health Research Centre, Level 6, Centre for Children's Health Research (CCHR), South Brisbane QLD, Australia
- Corresponding author.
| | - Hogarth Stephanie
- Paediatric Intensive Care Unit, Queensland Children's Hospital, 501 Stanley Street, South Brisbane QLD, Australia
| | - Rashid Muddassir
- Paediatric Interventional Radiology Unit, Medical Imaging, Queensland Children's Hospital, South Brisbane QLD, Australia
| | - Masters Ian Brent
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane QLD, Australia
| | - Anderson Benjamin
- Child Health Research Centre, Level 6, Centre for Children's Health Research (CCHR), South Brisbane QLD, Australia
- Queensland Paediatric Cardiology Research Group, Children’s Health Queensland, 501 Stanley Street, South Brisbane, QLD, Australia
- Queensland Paediatric Cardiac Service, Children's Health Queensland, South Brisbane QLD, Australia
| | - Borzi Peter
- Department of Neonatal and Paediatric Surgery, Queensland Children's Hospital, South Brisbane QLD, Australia
| | - Grips Martin
- Queensland Paediatric Cardiology Research Group, Children’s Health Queensland, 501 Stanley Street, South Brisbane, QLD, Australia
- Queensland Paediatric Cardiac Service, Children's Health Queensland, South Brisbane QLD, Australia
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26
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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]
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27
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Abstract
Aneurysms of the pulmonary arteries and trunk are rare entities. The Waterston shunt is a palliative procedure for children with cyanotic CHD due to obstruction of the pulmonary outflow. Described complications are distortion of the pulmonary artery and pulmonary arterial hypertension. We report a patient with a giant right pulmonary artery aneurysm in relation to a Waterston shunt.
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28
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Worku BM, de Angelis P, Wingo ME, Leonard JR, Khan FM, Hameed I, Ruan Y, Gaudino MFL, Girardi LN. Pulmonary artery aneurysms: Preoperative, intraoperative, and postoperative findings. J Card Surg 2019; 34:570-576. [PMID: 31090116 DOI: 10.1111/jocs.14070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/25/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulmonary artery aneurysms (PAAs) are a rare but potentially lethal cardiovascular pathology. PAAs tend to develop in young patients with no gender discrepancy; they are most often associated with congenital heart disorders but also with systemic infections, vasculitis, pulmonary arterial hypertension, chronic pulmonary embolism, and malignancies. Dissection and rupture carry significant morbidity and mortality, thus patients require careful management, especially those with associated pulmonary hypertension. Given the rarity of this condition, physicians have yet to establish standard treatment guidelines. Most studies published to date are case reports with one or two patients; here, we describe our experience with six cases of large PAAs treated surgically at our institution. METHODS We identified and retrospectively analyzed clinical data for patients who underwent surgery for PAAs between 2009 and 2017. RESULTS The average age at surgery was 59.73 years, five patients were females, and 83.3% had baseline hypertension. Systolic murmurs were the most common clinical finding. The average aneurysmal size was 65.0 mm. We repaired the PAA with a woven Dacron graft (22-26 mm) in four patients. We performed concomitant pulmonary valve procedures on five patients: four replacements and one repair. Mean pump and cross-clamp times were 108.5 and 65 minutes. Operative and 30-day mortality was 0%. Average length of stay was 10.5 days. CONCLUSIONS Postoperative mortality was 0%; all patients showed improvement of symptoms after surgery. These findings confirm that PAA repair has an acceptable risk profile in select patients.
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Affiliation(s)
- Berhane M Worku
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Paolo de Angelis
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Matthew E Wingo
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Jeremy R Leonard
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Faiza M Khan
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Yongle Ruan
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
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Akagi S, Ejiri K, Kasahara S, Nakamura K, Ito H. Improvement of lung function and pulmonary hypertension after pulmonary aneurysm repair: case series. Pulm Circ 2019; 9:2045894019831217. [PMID: 30698485 PMCID: PMC6378441 DOI: 10.1177/2045894019831217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pulmonary artery aneurysms (PAA) can be complicated with pulmonary arterial hypertension (PAH), causing sudden death due to PA rupture and dissection. Because treatment with PAH-targeted drugs does not always prevent PAA progression, prophylactic surgical repair of the PAA seems a promising alternative. However, although it avoids rupture and dissection of the PAs, additional benefits have not been forthcoming. We therefore present two patients with co-existing PAH and a PAA who underwent surgical repair of the aneurysm. Following the surgery, their lung function and pulmonary hypertension improved. Optimal treatment of PAA remains uncertain, however, with no clear guidelines regarding the best therapeutic approach. This case series provides physicians with reasons to repair PAA surgically in patients with PAH.
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Affiliation(s)
- Satoshi Akagi
- 1 Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Kentaro Ejiri
- 1 Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Shingo Kasahara
- 2 Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Kazufumi Nakamura
- 1 Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hiroshi Ito
- 1 Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
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30
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Zhang L, Li Y, Lv Q, Yuan L. Pulmonary artery aneurysm secondary to patent arterial duct and infection: A case report and review. Echocardiography 2018; 35:1878-1881. [PMID: 30267632 DOI: 10.1111/echo.14138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/01/2022] Open
Abstract
Pulmonary artery aneurysms (PAAs) are very rare condition. In this paper, we report a case of a twenty-year-old female patient with the aneurysm of the pulmonary trunk secondary to the patent arterial duct (PDA) and infection. Diagnosis of PAA was confirmed by echocardiography. The pulmonary artery computed tomographic angiography also revealed the aneurysm and drawn a similar conclusion as echo did. The patient underwent surgery of ligation of PDA and PAA aneurysmectomy repairing with pericardium graft.
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Affiliation(s)
- Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Yuan
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
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Greaves SW, Dye L, Aranda PS, Cain MT, Haasler GB, Almassi GH, Pagel PS, Kreibich M, Beyersdorf F, Elefteriades JA. Perioperative Management of a Large Idiopathic Pulmonary Artery Aneurysm Without Pulmonary Arterial Hypertension. J Cardiothorac Vasc Anesth 2018; 32:2402-2408. [PMID: 29887125 DOI: 10.1053/j.jvca.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Spencer W Greaves
- Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Lonnie Dye
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Patrick S Aranda
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Michael T Cain
- Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - George B Haasler
- Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany
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Prevalence and prognostic significance of pulmonary artery aneurysms in adults with congenital heart disease. Int J Cardiol 2018; 270:120-125. [PMID: 29891239 DOI: 10.1016/j.ijcard.2018.05.129] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/02/2018] [Accepted: 05/30/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prevalence and prognostic significance of pulmonary artery (PA) dilatation in congenital heart disease (CHD) have never been studied systematically. METHODS Chest X-rays of 1192 consecutive adults with CHD were reviewed. Major diameter of the PA was determined by imaging techniques in those with PA dilatation. A value >29 mm was considered abnormal. Data on anatomy, hemodynamics, residual lesions and outcomes were retrospectively collected. RESULTS Overall prevalence of PA dilatation was 18%. A minority of patients (5.5%) reached 40 mm (aneurysm; PAA) and 1.8% exceeded 50 mm. The most common PAA underlying malformations were pulmonary stenosis (21%), and shunts (55%). Significantly larger diameters were observed in hypertensive shunts (40 mm; IQR 36.7-45 mm vs. 34 mm; IQR 32-36 mm) (p < 0.0001). However, the largest diameters were found in cono-truncal anomalies. There was no significant correlation between PA dimensions and systolic pulmonary pressure (r = -0.196), trans-pulmonary gradient (r = -0.203), pulmonary regurgitation (PR) (r = 0.071) or magnitude of shunt (r = 0.137) (p > 0.05 for all). Over follow-up, 1 sudden death (SD) occurred in one Eisenmenger patient. Complications included coronary (3), recurrent laryngeal nerve (1) and airway (1) compressions, progressive PR (1), and PA thrombosis (1). Coronary compression and SD were strongly associated (univariate analysis) with pulmonary hypertension (120 vs. 55 mm Hg; p = 0.002) but not with extreme PA dilatation (range: 40-65 mm). CONCLUSIONS PA dilatation in CHD is common but only a small percentage of patients have PAA. Clinical impact on outcomes is low. Complications occurred almost exclusively in patients with pulmonary hypertension whereas PA diameter alone was not associated with adverse outcomes.
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Valente T, Abu-Omar A, Sica G, Clemente A, Muto M, Bocchini G, Cappabianca S, Rea G. Acquired peripheral pulmonary artery aneurysms: morphological spectrum of disease and multidetector computed tomography angiography findings-cases series and literature review. Radiol Med 2018; 123:664-675. [PMID: 29721920 DOI: 10.1007/s11547-018-0900-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/20/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Acquired peripheral or intraparenchymal pulmonary artery aneurysms (PPAA) are rare entities but are important to recognize because of the associated morbidity. Hemoptysis is their principal complication and is a potentially fatal condition. PURPOSE To illustrate the causes, multidetector CT angiography (MDCTA) findings and differential diagnosis of acquired PPAA. MATERIALS AND METHODS The institutional review boards approved this study. We conducted a retrospective review of the demographic data and the results of clinical and laboratory examinations, and imaging studies of patients managed between January 2012 and January 2017 in two institutions. RESULTS A total of 19 patients had acquired PPAA that were detected at MDCTA, 9 patients with normal pulmonary artery pressures and 10 with pulmonary hypertension. Nine patients developed PPAA-related acute symptoms. MDCTA features of PPAA include: a lobulated vascular mass, an indistinct irregular arterial wall, aneurysmal thrombosis or wall calcification, findings of impending rupture including perianeurysmal edema, gas or a soft tissue mass. CONCLUSION PPAA are rare. In our series, endocarditis and pulmonary hypertension are the PPAA leading causes. The treatment modality preferred is embolization, especially as surgery poses a very high risk for patients with severe pulmonary hypertension. Further clarification of the natural history of these rare arterial aneurysms is needed.
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Affiliation(s)
- Tullio Valente
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, P.O. Monaldi, Via Leonardo Bianchi, 80131, Naples, Italy.
| | - Ahmad Abu-Omar
- Department of Radiology, The James Cook University Hospital NHS Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Giacomo Sica
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, P.O. Monaldi, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Alfredo Clemente
- Department of Radiology and Radiotherapy, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Massimo Muto
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, P.O. Monaldi, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Giorgio Bocchini
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, P.O. Monaldi, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Salvatore Cappabianca
- Department of Radiology and Radiotherapy, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Gaetano Rea
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, P.O. Monaldi, Via Leonardo Bianchi, 80131, Naples, Italy
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Moghaddam N, Moghaddam B, Dehghan N, Brunner NW. Isolated large vessel pulmonary vasculitis leading to pulmonary artery aneurysm formation: a case report and literature review. Pulm Circ 2018; 8:2045894018765346. [PMID: 29488418 PMCID: PMC5871219 DOI: 10.1177/2045894018765346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Pulmonary artery (PA) vasculitis occurs in association with primary vasculitides—in particular, giant cell arteritis, Takayasu’s arteritis, or Behçet’s disease—or secondary vasculitis as a result of infections or malignancy. However, PA vasculitis in isolation and with concomitant aneurysmal dilation is an unusual finding. We present a rare case of PA aneurysm secondary to isolated PA vasculitis in an asymptomatic patient with no features of systemic vasculitis. This case highlights one of the first cases of PA vasculitis managed with surgical resection alone.
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Affiliation(s)
- Nima Moghaddam
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bahar Moghaddam
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Natasha Dehghan
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada
| | - Nathan W. Brunner
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Divison of Cardiology, University of British Columbia, Vancouver, BC, Canada
- Nathan W. Brunner, Gordon and Leslie Diamond Health Care Center, Pulmonary Hypertension Clinic, 7th floor, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9.
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Pallangyo P, Lyimo F, Bhalia S, Makungu H, Nyangasa B, Lwakatare F, Suranyi P, Janabi M. Bilateral multiple pulmonary artery aneurysms associated with cavitary pulmonary tuberculosis: a case report. J Med Case Rep 2017; 11:196. [PMID: 28720136 PMCID: PMC5516347 DOI: 10.1186/s13256-017-1360-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/22/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pulmonary artery aneurysms constitute <1% of aneurysms occurring in the thoracic cavity. Congenital cardiac defects are responsible for the majority (>50%) of cases, however, pulmonary artery aneurysm is a rare sequelae of pulmonary tuberculosis reported in about 5% of patients with chronic cavitary tuberculosis on autopsy. The natural history of this potentially fatal condition remains poorly understood and guidelines for optimal management are controversial. CASE PRESENTATION A 24-year-old man, a nursing student of African descent, was referred to us from an up-country regional hospital with a 4-week history of recurrent episodes of breathlessness, awareness of heartbeats and coughing blood 3 weeks after completing a 6-month course of anti-tuberculosis drugs. A physical examination revealed conjuctival and palmar pallor but there were no stigmata of connective tissue disorders, systemic vasculitides or congenital heart disease. An examination of the cardiovascular system revealed accentuated second heart sound (S2) with early diastolic (grade 1/6) and holosystolic (grade 2/6) murmurs at the pulmonic and tricuspid areas respectively. Blood tests showed iron deficiency anemia, prolonged bleeding time, and mild hyponatremia. A chest radiograph revealed bilateral ovoid-shaped perihilar opacities while a computed tomography scan showed bilateral multiple pulmonary artery pseudoaneurysms with surrounding hematoma together with adjacent cystic changes, consolidations, and tree-in-bud appearance. Our patient refused to undergo surgery and died of aneurismal rupture after 9 days of hospitalization. CONCLUSIONS The presence of intractable hemoptysis among patients with tuberculosis even after completion of anti-tuberculosis course should raise an index of suspicion for pulmonary artery aneurysm. Furthermore, despite of its rarity, early recognition and timely surgical intervention of pulmonary artery aneurysm is crucial to reducing morbidity and preventing the attributed mortality.
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Affiliation(s)
- Pedro Pallangyo
- Department of Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Frederick Lyimo
- Department of Radiology, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Department of Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Hilda Makungu
- Department of Radiology, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania
| | - Bashir Nyangasa
- Department of Cardiovascular Surgery, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Flora Lwakatare
- Department of Radiology, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania
| | - Pal Suranyi
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courteney Drive, MSC 226, Charleston, SC 29425 USA
| | - Mohamed Janabi
- Department of Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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Afrikh K, Hattach L, Fellat N, El Bakkali M, Benjelloun H. Aneurysm of the Pulmonary Artery in Fallot's Tetralogy. Case Rep Cardiol 2017; 2017:1384905. [PMID: 28611926 PMCID: PMC5458364 DOI: 10.1155/2017/1384905] [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: 01/30/2017] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Pulmonary artery aneurysms are a rare entity. Etiologies of these findings are multiple, but they are exceptionally associated with Fallot's Tetralogy. In this study, we present an unusual case of an important aneurysm of the left pulmonary artery associated with Fallot's Tetralogy disease. CASE PRESENTATION A 30-year-old woman has been admitted for dyspnea and cyanosis. The data which had been obtained from echocardiography, cardiac catheterization, and angio-magnetic resonance imaging (MRI) suggested the existence of an important aneurysm of the left pulmonary artery associated with a regular Fallot's disease with a pulmonic stenosis. We have noticed the presence of a small restrictive patent ductus arteriosus (PDA). Therefore, the patient was referred to surgical correction. CONCLUSION Pulmonary artery aneurysms associated with Fallot's Tetralogy are rarely reported. The natural history of these rare arterial aneurysms has to be clarified.
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Affiliation(s)
- Kawtar Afrikh
- Unit of Cardiology A, Ibn Sina University Hospital, Rabat, Morocco
| | - Loua Hattach
- Unit of Cardiology A, Ibn Sina University Hospital, Rabat, Morocco
| | - Nadia Fellat
- Unit of Cardiology A, Ibn Sina University Hospital, Rabat, Morocco
| | - Mustapha El Bakkali
- Physiology of Exercise Team (EPE), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
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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.
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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
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Malviya A, Jha PK, Kalita JP, Saikia MK, Mishra A. Idiopathic dilatation of pulmonary artery: A review. Indian Heart J 2017; 69:119-124. [PMID: 28228295 PMCID: PMC5319124 DOI: 10.1016/j.ihj.2016.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/21/2016] [Accepted: 07/07/2016] [Indexed: 11/09/2022] Open
Abstract
The diagnosis of idiopathic dilatation of pulmonary artery is challenging because its clinical recognition is difficult and various other causes of dilated pulmonary artery need to be excluded. The clinical findings mimic various common cardiac disorders and both invasive and non-invasive investigations should be done to arrive at the diagnosis. It is a known clinical entity but etiology and pathophysiology are largely unknown. The current echocardiographic and catheterization based diagnostic criteria, may not be satisfied completely in a particular patient and need to be revisited in view of newer imaging modalities. There is paucity of information about the natural history of the disease with attendant lack of clarity in treatment guidelines. Certain cases may progress to huge dilatation and consequent serious implications. It is a rare disease and is the diagnosis of exclusion.
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Affiliation(s)
- Amit Malviya
- Department of Cardiology, Northeastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong 18, Meghalaya, India
| | - Pravin K Jha
- Department of Cardiology, Northeastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong 18, Meghalaya, India
| | - Jyoti P Kalita
- Department of CTVS, Northeastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong 18, Meghalaya, India
| | - Manuj K Saikia
- Department of CTVS, Northeastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong 18, Meghalaya, India
| | - Animesh Mishra
- Department of Cardiology, Northeastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong 18, Meghalaya, India.
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Cardiac dysfunction of pulmonary artery aneurysm in patients with pulmonary arterial hypertension. Int J Cardiol 2016; 228:1035-1040. [PMID: 27931011 DOI: 10.1016/j.ijcard.2016.10.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/28/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Pulmonary artery aneurysm (PAA) occurs in some patients with pulmonary arterial hypertension (PAH). We evaluated the characteristics of cardiac dysfunction in patients with PAH complicated by PAA. METHODS Echocardiography and right-heart catheterization were performed in 130 PAH patients to measure the maximum dimensions of the main pulmonary artery (MPA) trunk and evaluate right ventricular (RV) and left ventricular (LV) function. RESULTS A diameter of >40mm was defined as PAA in the MPA trunk. The maximum MPA diameter was >40mm in 32 of 130 PAH patients (24.6%: Group PAA). Systolic pulmonary artery pressure (68.0±18.5 vs. 58.9±21.6mm Hg, P=0.0354) and pulmonary capillary wedge pressure (10.8±3.9 vs. 7.7±2.6mm Hg, P<0.0001) were significantly higher in Group PAA than in Group non-PAA. RV end-diastolic area index (19.6±6.8 vs. 14.9±5.1 cm²/m², P<0.0001), and RV fractional area change (32.3±7.8 vs. 37.3±8.8%, P=0.0048) and RV longitudinal strain (-15.4±5.1 vs. -20.4±6.1, P=0.0012) were significantly lower, and E/e' was significantly higher (8.1±2.2 vs. 6.7±1.4, P=0.0002) in Group PAA than in Group non-PAA. CONCLUSIONS In PAH patients with PAA, RV was larger and RV dysfunction was more severe, and LV diastolic dysfunction appeared. It is important to investigate the appearance of PAA and the severity of RV and LV dysfunction in PAH patients with PAA.
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Kumar B, Munirathinam GK, Mishra AK, Arya VK. Giant Peripheral Pulmonary Artery Aneurysm Rupture Under Anesthesia-A Sequela of Positive-Pressure Ventilation. J Cardiothorac Vasc Anesth 2016; 31:279-282. [PMID: 27499344 DOI: 10.1053/j.jvca.2016.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Bhupesh Kumar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ganesh K Munirathinam
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anand K Mishra
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra K Arya
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Santos-Martínez LE, Meza-López LR, Flores-García CA, Rodríguez-Almendros NA, Hernández-Meneses S, Lozano-Torres VM, Rodríguez GP. [Aneurysm in the main pulmonary artery in patient with pulmonary hypertension: Successful surgical treatment]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 86:185-8. [PMID: 26530168 DOI: 10.1016/j.acmx.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/03/2015] [Accepted: 09/14/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Luis Efren Santos-Martínez
- Departamento de Hipertensión Pulmonar y Función Ventricular Derecha, Unidad Médica de Alta Especialidad, Hospital de Cardiología del Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México.
| | - Luis Raúl Meza-López
- Departamento de Cirugía Cardiotorácica, Unidad Médica de Alta Especialidad, Hospital de Cardiología del Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - Cesar Antonio Flores-García
- Departamento de Patología, Unidad Médica de Alta Especialidad, Hospital de Cardiología del Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - Nielzer Armando Rodríguez-Almendros
- Departamento de Hipertensión Pulmonar y Función Ventricular Derecha, Unidad Médica de Alta Especialidad, Hospital de Cardiología del Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - Silvia Hernández-Meneses
- Departamento de Cirugía Cardiotorácica, Unidad Médica de Alta Especialidad, Hospital de Cardiología del Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - Victor Manuel Lozano-Torres
- Departamento de Cirugía Cardiotorácica, Unidad Médica de Alta Especialidad, Hospital de Cardiología del Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - Gilberto Pérez Rodríguez
- Dirección General, Unidad Médica de Alta Especialidad, Hospital de Cardiología del Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
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Albertson M, Jamous F, Groskreutz D. Expansive pulmonary artery aneurysm in an IV drug user. BMJ Case Rep 2015; 2015:bcr-2014-208556. [PMID: 25616655 DOI: 10.1136/bcr-2014-208556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Megan Albertson
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Fady Jamous
- Department of Pulmonary & Sleep Medicine, Avera Medical Group, Sioux Falls, South Dakota, USA Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Dayna Groskreutz
- Department of Pulmonary & Sleep Medicine, Avera Medical Group, Sioux Falls, South Dakota, USA
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Sheikhzadeh S, De Backer J, Gorgan NR, Rybczynski M, Hillebrand M, Schüler H, Bernhardt AM, Koschyk D, Bannas P, Keyser B, Mortensen K, Radke RM, Mir TS, Kölbel T, Robinson PN, Schmidtke J, Berger J, Blankenberg S, von Kodolitsch Y. The main pulmonary artery in adults: a controlled multicenter study with assessment of echocardiographic reference values, and the frequency of dilatation and aneurysm in Marfan syndrome. Orphanet J Rare Dis 2014; 9:203. [PMID: 25491897 PMCID: PMC4272795 DOI: 10.1186/s13023-014-0203-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Echocardiographic upper normal limits of both main pulmonary artery (MPA) diameters (MPA-d) and ratio of MPA to aortic root diameter (MPA-r) are not defined in healthy adults. Accordingly, frequency of MPA dilatation based on echocardiography remains to be assessed in adults with Marfan syndrome (MFS). METHODS We enrolled 123 normal adults (72 men, 52 women aged 42 ± 14 years) and 98 patients with MFS (42 men, 56 women aged 39 ± 14 years) in a retrospective cross-sectional observational controlled study in four tertiary care centers. We defined outcome measures including upper normal limits of MPA-d and MPA-r as 95 quantile of normal persons, MPA dilatation as diameters > upper normal limits, MPA aneurysm as diameters >4 cm, and indication for surgery as MPA diameters >6 cm. RESULTS MPA diameters revealed normal distribution without correlation to age, sex, body weight, body height, body mass index and body surface area. The upper normal limit was 2.6 cm (95% confidence interval (CI) =2.44-2.76 cm) for MPA-d, and 1.05 (95% CI = .86-1.24) for MPA-r. MPA dilatation presented in 6 normal persons (4.9%) and in 68 MFS patients (69.4%; P < .001), MPA aneurysm presented only in MFS (15 patients; 15.3%; P < .001), and no patient required surgery. Mean MPA-r were increased in MFS (P < .001), but ratios >1.05 were equally frequent in 7 normal persons (5%) and in 8 MFS patients (10.5%; P = .161). MPA-r related to aortic root diameters (P = .042), reduced left ventricular ejection fraction (P = .006), and increased pulmonary artery systolic pressures (P = .040). No clinical manifestations of MFS and no FBN1 mutation characteristics related to MPA diameters. CONCLUSIONS We established 2.6 cm for MPA-d and 1.05 for MPA-r as upper normal limits. MFS exhibits a high prevalence of MPA dilatation and aneurysm. However, patients may require MPA surgery only in scarce circumstances, most likely because formation of marked MPA aneurysm may require LV dysfunction and increased PASP.
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Affiliation(s)
- Sara Sheikhzadeh
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Julie De Backer
- Centre for Medical Genetics, University Hospital Ghent, Ghent, Belgium.
| | - Neda Rahimian Gorgan
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Meike Rybczynski
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Mathias Hillebrand
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Helke Schüler
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Alexander M Bernhardt
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Dietmar Koschyk
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Hamburg, Germany.
| | - Britta Keyser
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany.
| | - Kai Mortensen
- Medizinische Klinik II / Kardiologie, Angiologie, am Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany.
| | - Robert M Radke
- Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster, Germany.
| | - Thomas S Mir
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Tilo Kölbel
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Peter N Robinson
- Institute of Medical Genetics, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Jörg Schmidtke
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany.
| | - Jürgen Berger
- Department of Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany.
| | - Stefan Blankenberg
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Yskert von Kodolitsch
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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