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Li FQ, Su DJ, Zhang WJ, Chen ZK, Li GX, Li SX, Peng YX, Dang L, Wang WH. Endovascular treatment for massive haemoptysis due to pulmonary pseudoaneurysm: report of 23 cases. J Cardiothorac Surg 2023; 18:244. [PMID: 37580779 PMCID: PMC10426096 DOI: 10.1186/s13019-023-02346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/09/2023] [Indexed: 08/16/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of endovascular treatment for massive haemoptysis caused by pulmonary pseudoaneurysm (PAP). METHODS The clinical data, imaging data, and endovascular treatment protocol of 23 patients with massive haemoptysis caused by continuous PAP were retrospectively analysed. The success, complications, postoperative recurrence rate, and influence of the treatment on pulmonary artery pressure were also evaluated. RESULTS Nineteen patients with a bronchial artery-pulmonary artery (BA-PA) and/or nonbronchial systemic artery-pulmonary artery (NBSA-PA) fistula underwent bronchial artery embolization (BAE) and/or nonbronchial systemic artery embolization (NBSAE) + pulmonary artery embolization (PAE). The pulmonary artery (PA) pressures before and after embolization were 52.11 ± 2.12 (35-69 cmH2O) and 33.58 ± 1.63 (22-44 cmH2O), respectively (P = 0.001). Four patients did not have a BA-PA and/or NBSA-PA fistula. Embolization was performed in two patients with a distal PAP of the pulmonalis lobar arteria. Bare stent-assisted microcoils embolization was performed in the other two patients with a PAP of the main pulmonary lobar arteries. The PA pressures of the four patients before and after treatment were 24.50 ± 1.32 (22-28 cmH2O) and 24.75 ± 1.70 (22-29 cmH2O), respectively (P = 0.850). The technique had a 100% success rate with no serious complications and a postoperative recurrence rate of 30%. CONCLUSION Endovascular treatment is safe and effective for massive haemoptysis caused by PAP. BAE and/or NBSAE can effectively reduce pulmonary hypertension in patients with a BA-PA and/or NBSA-PA fistula.
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Affiliation(s)
- Fen-Qiang Li
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China.
| | - Dong-Jun Su
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Wan-Jia Zhang
- Department of Vascular and Tumour Intervention, Liangzhou Hospital, Wuwei City, Gansu Province, China
| | - Zhong-Ke Chen
- Department of Interventional Radiology, Affiliated Hospital of Gansu Medical College, PingLiang, Gansu Province, China
| | - Geng-Xiang Li
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Shuang-Xi Li
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Yu-Xing Peng
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Lei Dang
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Wen-Hui Wang
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China.
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A Rare Case of Peripheral Pulmonary Artery Aneurysm and Cavitating Pneumonia in a Patient with COVID-19 Managed with an Endovascular Method. Radiol Case Rep 2022; 17:3694-3698. [PMID: 35936879 PMCID: PMC9342831 DOI: 10.1016/j.radcr.2022.06.087] [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: 05/30/2022] [Revised: 06/19/2022] [Accepted: 06/25/2022] [Indexed: 11/20/2022] Open
Abstract
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.
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Forbes LM, Hensley ND, Miller YE. A 58-Year-Old Woman With a History of Cardiac Myxoma Presents With Pulmonary Nodules. Chest 2021; 160:e351-e355. [PMID: 34625183 DOI: 10.1016/j.chest.2021.04.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/07/2021] [Accepted: 04/29/2021] [Indexed: 11/24/2022] Open
Abstract
CASE PRESENTATION A 58-year-old woman presented to a pulmonology clinic for evaluation of bilateral pulmonary nodules. Two years previously, she had presented with atrioventricular nodal reentrant tachycardia. During evaluation for her tachyarrhythmia, transthoracic echocardiogram (TTE) revealed a large, homogenous, highly mobile right atrial and ventricular mass. She underwent electrophysiologic ablation, tricuspid valve annular ring replacement, and resection of the mass, which pathology confirmed to be a myxoma. Now, a recent abdomen and pelvis CT study obtained for history of nephrolithiasis incidentally noted bilateral lower lobe pulmonary nodules. Follow-up noncontrast chest CT confirmed bilateral peribronchovascular solid pulmonary nodules up to 8 mm in diameter throughout all lobes. The nodules appeared contiguous with the segmental and subsegmental bronchovascular bundles, and many occurred at branch points. There was no mediastinal or hilar lymphadenopathy. To evaluate the pulmonary nodules, she was referred to a pulmonology clinic. She reported only stable, nonlimiting dyspnea on exertion. She did not have a cough. She denied a history of fevers, weight loss, or night sweats. She had no rash or skin changes, visual changes, joint pain or swelling, or palpitations. She had no history of oropharyngeal or genital ulcerations. Social history was notable for a 40-pack-year smoking history, with quit date 2 years prior. She had no risk factors for TB exposure and no exposures to sandblasting, stone cutting, or other environmental risk factors for silicosis. Family history was negative for autoimmune conditions, sarcoidosis, and lymphoproliferative disorders.
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Affiliation(s)
- Lindsay M Forbes
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Nathan D Hensley
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO
| | - York E Miller
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Nagato H, Nishiwaki N, Kaneda K, Tamura N. Surgical repair of a giant pulmonary artery aneurysm that caused severe left bronchial obstruction. Interact Cardiovasc Thorac Surg 2020; 31:266-267. [PMID: 32514518 DOI: 10.1093/icvts/ivaa082] [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: 02/10/2020] [Revised: 03/25/2020] [Accepted: 04/13/2020] [Indexed: 11/14/2022] Open
Abstract
A 63-year-old woman on oral steroids for systemic lupus erythematosus presented with a giant pulmonary artery aneurysm severely compressing the left main bronchus and lung. Her presenting symptom was severe respiratory distress. Surgical graft replacement of the main and branch pulmonary arteries was performed, and her respiratory function improved dramatically. Bronchial obstruction was resolved immediately after the procedure.
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Affiliation(s)
- Hisao Nagato
- Department of Cardiovascular Surgery, Amagasaki General Medical Center, Amagasaki, Japan
| | - Noboru Nishiwaki
- Department of Cardiovascular Surgery, Izuo Hospital, Osaka, Japan
| | - Kozo Kaneda
- Department of Cardiovascular Surgery, Takanohara Central Hospital, Nara, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Kindai University Nara Hospital, Ikoma, Japan
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Gupta M, Agrawal A, Iakovou A, Cohen S, Shah R, Talwar A. Pulmonary artery aneurysm: a review. Pulm Circ 2020; 10:2045894020908780. [PMID: 32166017 PMCID: PMC7052473 DOI: 10.1177/2045894020908780] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 01/22/2020] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Mridul Gupta
- Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA
| | - Abhinav Agrawal
- Division of Pulmonary, Critical Care and Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Annamaria Iakovou
- Division of Pulmonary, Critical Care and Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Stuart Cohen
- Department of Thoracic Radiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Rakesh Shah
- Department of Thoracic Radiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Arunabh Talwar
- Division of Pulmonary, Critical Care and Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
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Tuzun H, Seyahi E, Guzelant G, Oz B, Batur S, Demirhan O, Hamuryudan V. Surgical Treatment of Pulmonary Complications in Behçet's Syndrome. Semin Thorac Cardiovasc Surg 2018; 30:369-378. [PMID: 30031945 DOI: 10.1053/j.semtcvs.2018.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/11/2018] [Indexed: 11/11/2022]
Abstract
We described disease characteristics, management and outcome of a group of Behçet's syndrome (BS) patients who underwent pulmonary lobectomy, segmentectomy or various pleura interventions for complications due to pulmonary artery or descending aorta involvement. There were 9 patients with BS (8 M/1 F; mean age: 24.8 ± 7.5 and mean disease duration: 4.3 ± 3.8 years) who underwent lung surgery from 2000 to 2017. Their medical files including operation details and radiological and pathological studies were reviewed retrospectively. Lobectomy was done in 6 patients, decortications and pleura interventions in the remaining 3. The reason for the surgical procedures were giant pulmonary arterial aneurysms refractory to the medical treatment (n = 4), pneumothorax due to large cavities (n = 2), pleural effusions refractory to the medical treatment (n = 1), a bronchopleural fistula after embolization (n = 1) and bronchiectasis (n = 1). All patients received medical treatment with cyclophosphamide and corticosteroids before the surgical interventions. The histological examination in patients with pseudo-aneurysms showed destruction of medial elastic fibers, inflammatory cell infiltration of adventitial tissues and penetration into the adjacent bronchi with adherent thrombi. Two patients died: one due to Budd-Chiari syndrome 1 year after the surgery, another because of a massive hemoptysis 3 months after lobectomy. The remaining 7 patients are still alive with a median follow-up of 8 years (inter-quartile range [IQR]: 4-11). Lobectomies in BS patients with giant pulmonary aneurysms refractory to medical treatment can be done with favorable outcome. Also, complications such as large cavities causing pneumothorax, refractory pleural effusions, bronchiectasis, and embolization complications can be managed effectively with surgical interventions.
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Affiliation(s)
- Hasan Tuzun
- Department of Cardiovascular Surgery, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey.
| | - Emire Seyahi
- Division of Rheumatology, Department of Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - Gul Guzelant
- Division of Rheumatology, Department of Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - Buge Oz
- Department of Pathology, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - Sebnem Batur
- Department of Pathology, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - Ozkan Demirhan
- Department of Cardiothoracic Surgery, Istanbul Bilim University, Turkey
| | - Vedat Hamuryudan
- Division of Rheumatology, Department of Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey
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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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Park HS, Chamarthy MR, Lamus D, Saboo SS, Sutphin PD, Kalva SP. Pulmonary artery aneurysms: diagnosis & endovascular therapy. Cardiovasc Diagn Ther 2018; 8:350-361. [PMID: 30057881 DOI: 10.21037/cdt.2018.04.01] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary artery aneurysms (PAAs) and pseudoaneurysms are rare entities in the spectrum of pulmonary arterial diseases. The etiology of these aneurysms is varied and patients present with nonspecific symptoms which make their diagnosis both difficult and less often considered. In this review, we will discuss the clinical manifestations, etiologies, methods of detection, imaging features, and the current role of endovascular treatment in the management of PAAs.
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Affiliation(s)
- Harold S Park
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Murthy R Chamarthy
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel Lamus
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sachin S Saboo
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Patrick D Sutphin
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sanjeeva P Kalva
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ogul H, Kantarci M. Bronchiectasis due to an Ectopic Right Pulmonary Artery and Compression of the Superior Vena Cava between an Ascending Thoracic Aortic Aneurysm and Enlarged Right Pulmonary Artery. Med Princ Pract 2017; 26:84-86. [PMID: 27595472 PMCID: PMC5588302 DOI: 10.1159/000450578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 09/05/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to report multidetector computed tomography (CT) imaging findings relating to segmental pulmonary arterial ectasia (PAE), which is a very rare vascular condition. CLINICAL PRESENTATION AND INTERVENTION A 70-year-old woman presented with shortness of breath and increased production of purulent sputum. Chest CT angiography revealed bronchiectasis secondary to compression of the anterior segment bronchus of the right upper lobe because of a segmental PAE. She also had compression of the superior vena cava between an ascending thoracic aortic aneurysm and an ectopic enlarged right pulmonary artery. Conventional right upper lobectomy and angioplasty were planned, but the patient refused surgical therapy. CONCLUSION This report shows the importance of CT angiography in a case that involved an unusual coincidence of segmental PAE and ascending aortic aneurysm.
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Affiliation(s)
- Hayri Ogul
- *Hayri Ogul, MD, Department of Radiology, Medical Faculty, Ataturk University, Kazim Karabekir Mah. Terminal Cad., Site Polat Apt. B Blok, Kat 1, No. 2, TR–25240 Erzurum (Turkey), E-Mail
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Affiliation(s)
- Maximilian Kreibich
- From the Departments of Cardiovascular Surgery (M.K., M.S., J.K., F.B.) and Congenital Heart Disease and Paediatric Cardiology (R.H., J.G.), Heart Centre Freiburg University, Freiburg, Germany
| | - Matthias Siepe
- From the Departments of Cardiovascular Surgery (M.K., M.S., J.K., F.B.) and Congenital Heart Disease and Paediatric Cardiology (R.H., J.G.), Heart Centre Freiburg University, Freiburg, Germany
| | - Johannes Kroll
- From the Departments of Cardiovascular Surgery (M.K., M.S., J.K., F.B.) and Congenital Heart Disease and Paediatric Cardiology (R.H., J.G.), Heart Centre Freiburg University, Freiburg, Germany
| | - René Höhn
- From the Departments of Cardiovascular Surgery (M.K., M.S., J.K., F.B.) and Congenital Heart Disease and Paediatric Cardiology (R.H., J.G.), Heart Centre Freiburg University, Freiburg, Germany
| | - Jochen Grohmann
- From the Departments of Cardiovascular Surgery (M.K., M.S., J.K., F.B.) and Congenital Heart Disease and Paediatric Cardiology (R.H., J.G.), Heart Centre Freiburg University, Freiburg, Germany
| | - Friedhelm Beyersdorf
- From the Departments of Cardiovascular Surgery (M.K., M.S., J.K., F.B.) and Congenital Heart Disease and Paediatric Cardiology (R.H., J.G.), Heart Centre Freiburg University, Freiburg, Germany
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