An unusual cause of pulmonary artery pseudoaneurysm: acrylate embolism

A Rare Case of Peripheral Pulmonary Artery Aneurysm and Cavitating Pneumonia in a Patient with COVID-19 Managed with an Endovascular Method

Peripheral pulmonary artery aneurysm (PAA), being a rare condition, is considered extremely rare following coronavirus disease 2019 (COVID-19). We present a 58-year-old male who presented with fever, malaise, and dry cough. SARS-CoV-RNA transcription-mediated amplification test was positive for the patient. After 2 days, he developed hemoptysis and back pain, and a CT scan revealed a pulmonary aneurysm, evidence of alveolar hemorrhage, and Necrotizing pneumonia. He was scheduled for pulmonary artery angiography. The angiography confirmed a fusiform aneurysm and partial coiling of the aneurysmal sac, and indoor and backdoor embolization was performed. In the follow-up, a CT scan showed complete thrombosis of the aneurysmal sac, and the patient was free of symptoms. Peripheral PAAs can show a variety of symptoms. They can even be asymptomatic. The infectious pathologies of this condition are less common than the other. COVID-19 is an extremely rare pathology. To the best of our knowledge, this is the first case of necrotizing pneumonia and peripheral PPA in an adult. Moreover, it was followed by COVID-19. A vital takeaway note for physicians is to consider PAAs as a complication when treating COVID-19 patients who don't show signs of improvement or even show signs of exacerbation.

Pulmonary artery aneurysm: a review

Pulmonary artery aneurysm is a rare but important entity in the spectrum of pulmonary vascular diseases. The etiologies can be varied and patients can present with non-specific symptoms with the diagnosis being incidental. There is limited consensus regarding the diagnostic criteria and follow-up imaging for patients diagnosed with this entity. Further the management strategies can be variable depending upon underlying disease, etiology, center dependent expertise, and resources available. We review the etiologies, epidemiology, classification, clinical manifestations, and imaging features of pulmonary artery aneurysm. We also review the current management strategies and suggest an algorithmic approach to these patients.

[Diagnosis and Management of Postoperative Acute Pulmonary Embolism after Thoracic Surgeries - Experience of Diagnosis and Management for 37 Patients with Postoperative Acute Pulmonary Embolism after Thoracic Surgeries]

背景与目的

肺栓塞（pulmonary embolism, PE）是胸外科术后最严重的并发症之一，因此充分了解胸外科术后急性PE患者所具有的临床特点具有重要意义。本研究通过总结37例胸外科术后急性PE患者的临床特点及诊治体会，从而提高胸外科术后急性PE的预防及诊治水平。

方法

对37例胸外科术后急性PE患者进行回顾性分析，对性别、年龄、体重指数（body mass index, BMI）、诊断及手术术式及术后发生PE时间、临床表现、诊断及治疗过程进行综合分析。

结果

37例患者中男16例（43.2%），女21例（56.8%），平均年龄为（65.64±6.29）岁（53岁-82岁），32例患者年龄超过60岁（86.5%）。BMI范围位于17.1 kg/m²-30.8 kg/m²之间，中位BMI为26.3 kg/m²，27例（73.0%）患者的BMI超过25.0 kg/m²。恶性肿瘤34例（91.9%）。中位发病时间为术后第4天，其中发生在术后第3天的患者有11例，所占比例（29.7%）最高。上午9点至晚上9点发生PE的比例可达77.8%。术后D二聚体（D-dimer, D-D）波动在1.0 μg/mL-20.0 μg/mL（FEU）之间，平均值为（7.09±4.45）μg/mL（FEU），其中32例（86.5%）患者的术后D-D高于3.00 μg/mL（FEU）。

结论

充分掌握胸外科术后急性PE患者的临床特点，及早发现诊断并采取多学科治疗能大大提高疾病生存率。

Thromboembolic Events Secondary to Endoscopic Cyanoacrylate Injection: Can We Foresee Any Red Flags?

BACKGROUND

Gastric varices (GV) are associated with high morbidity and mortality in patients with portal hypertension. Endoscopic cyanoacrylate injection is the first-line recommended therapy for GV obliteration. This study aims to explore the reason behind related adverse events and better prevent its occurrence.

METHODS

A retrospective case series study was conducted from January 1, 2013, to December 31, 2016, to identify patients who experienced severe adverse events secondary to endoscopic cyanoacrylate injection. A literature review of similar cases was performed on two medical databases, Medline and Embase.

RESULTS

A total of 652 patients underwent cyanoacrylate injection at our center within the study duration. Five cases of severe adverse events related to the use of tissue adhesives were identified. Detailed clinical presentation, patient treatment, and outcomes were reviewed and analyzed. Twenty-seven similar cases were identified based on the literature review providing further insight into the study.

CONCLUSION

Although rare in incidence, systemic embolism associated with cyanoacrylate injection is often fatal or debilitating. This report may raise awareness in treatment protocol, including the necessity of preoperative angiographic studies, to avoid similar adverse events in clinical practice.

Postoperative Acute Pulmonary Embolism Following Pulmonary Resections

Postoperative acute pulmonary embolism after pulmonary resections is highly fatal complication. Many literatures have documented cancer to be the highest risk factor for acute pulmonary embolism after pulmonary resections. Early diagnosis of acute pulmonary embolism is highly recommended and computed tomographic pulmonary angiography is the gold standard in diagnosis of acute pulmonary embolism. Anticoagulants and thrombolytic therapy have shown a great success in treatment of acute pulmonary embolism. Surgical therapies (embolectomy and inferior vena cava filter replacement) proved to be lifesaving but many literatures favored medical therapy as the first choice. Prophylaxis pre and post operation is highly recommended, because there were statistical significant results in different studies which supported the use of prophylaxis in prevention of acute pulmonary embolism. Having reviewed satisfactory number of literatures, it is suggested that thoroughly preoperative assessment of patient conditions, determining their risk factors complicating to pulmonary embolism and the use of appropriate prophylaxis measures are the key options to the successful minimization or eradication of acute pulmonary embolism after lung resections.