Pulmonary artery aneurysm presenting as a lung mass

Pulmonary artery aneurysm protruding into the bronchus as an endobronchial mass: A case report

BACKGROUND

Pulmonary artery (PA) aneurysms are usually diagnosed radiographically and present as small or large lesions resembling inflammation or a neoplasm on chest radiography. It has rarely been reported as an endobronchial mass.

CASE SUMMARY

We report the case of a 64-year-old man who presented with recurrent hemoptysis. Bronchoscopy revealed a tumorous protrusion blocking the right middle lobe bronchus, which was confirmed to be a PA aneurysm using endobronchial ultrasound bronchoscopy and computed tomography angiography.

CONCLUSION

Although endobronchial PA aneurysms are rare, bronchoscopists need to add this lesion to the list of endobronchial masses for which a biopsy is to be assiduously avoided.

Surgical approach to a mycotic aneurysm of the pulmonary artery presenting with hemoptysis - A case report and a review of the literature

INTRODUCTION

Mycotic aneurysms of the pulmonary arteries are very rare and have high mortality. Risk groups are intravenous drug users and patients with congenital heart disorders. The surgical approach varies due to a limited number of reported cases.

PRESENTATION OF CASE

We present a case of a mycotic aneurysm of the right pulmonary artery in a 56-year old man presenting with recurrent pneumonias, weight loss and hemoptysis.

DISCUSSION

There is often a diagnostic delay because of non-specific symptoms mimicking more common disorders. Treatment strategies include conservative management, surgery and endovascular treatment.

CONCLUSION

This report demonstrates a rare case of aneurysm of the pulmonary artery presenting with hemoptysis. For rapidly progressing proximal aneurysms of the pulmonary arteries, the midline surgical approach is recommended.

Acquired peripheral pulmonary artery aneurysms: morphological spectrum of disease and multidetector computed tomography angiography findings-cases series and literature review

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.

Mycotic pseudoaneurysm of a pulmonary artery branch caused by Cladosporium

We report the case of a 53-year-old male with a history of acute myelogenous leukemia, who suffered the rupturing of a right-sided pulmonary artery pseudoaneurysm combined with pneumonia. He underwent a right-sided lower lobectomy. The resected lung tissue demonstrated a mycotic pseudoaneurysm of a pulmonary artery branch together with a filamentous fungal infection. Pseudoaneurysms are caused by the breaching of all layers of a blood vessel wall. The extravasated blood is trapped by the surrounding extravascular tissue or clots. Cladosporium was detected during a polymerase chain reaction-based analysis followed by DNA sequencing of formalin-fixed paraffin-embedded lung tissue samples. Although previous cases of pulmonary artery pseudoaneurysms caused by fungal infections, e.g., Candida or Aspergillus sp., have been reported, to the best of our knowledge this is the first case to involve cladosporiosis.

Pulmonary Artery Pseudoaneurysms: Clinical Features and CT Findings

OBJECTIVE

The purpose of this study was to analyze the clinical and CT features of pulmonary artery pseudoaneurysms (PAPs).

MATERIALS AND METHODS

A database search of chest CT examinations performed from January 1, 2000 to December 31, 2014 identified 24 patients with findings consistent with PAPs. A CT finding consistent with a PAP was defined as a focal saccular outpouching of a pulmonary artery. Medical records were reviewed to determine clinical presentations, treatments, and outcomes. CT scans were reviewed by two board-certified fellowship-trained chest radiologists.

RESULTS

A total of 35 PAPs were identified in 24 patients. Hemoptysis and shortness of breath were the most common presenting symptoms. The most commonly identified causes of PAPs were infection (33%), neoplasms (13%), and trauma (17%). Of the 35 PAPs, 29 (83%) were located in segmental or subsegmental pulmonary arteries. A solitary PAP was identified in 20 (83%) patients, and multiple PAPs were identified in three patients with endocarditis and one patient with pulmonary metastases. Only three of 35 (9%) PAPs were associated with a ground-glass halo. Endovascular treatment was successfully performed in 12 patients, and only one patient had immediate recurrent hemoptysis after treatment. PAP was clinically suspected by the referring clinicians in only three patients. Sixteen of the 35 (46%) PAPs were not reported on the initial CT studies.

CONCLUSION

PAPs showed a strong predilection for the peripheral pulmonary arteries. Multiplicity of PAPs can be seen in the settings of endocarditis and pulmonary metastatic disease. Most PAPs were not associated with a ground-glass halo. PAPs can be lethal but were often not suspected clinically and were underreported by radiologists.

Ultrasound-Aided Diagnosis of Pulmonary Artery Pseudoaneurysm in a Pediatric Patient

Pulmonary artery pseudoaneurysm (PAP) is an uncommon entity associated with high mortality if left untreated. PAPs are most often acquired secondary to trauma, inflammation, infection, or malignancy. The most common presentation is hemoptysis, but many patients are asymptomatic. Because of the increased risk of enlargement and rupture, timely diagnosis and intervention is necessary. Imaging plays an essential role not only in diagnosis of this entity but also in intervention. We describe a case using gray-scale and color Doppler imaging providing sonographically aided diagnosis and follow-up of a clinically silent PAP in a pediatric patient.

Giant pulmonary artery aneurysm secondary to patent ductus arteriosus: a case report

Aneurysms involving the main pulmonary artery and its branches are rare. Clinical experience is limited, and their management is not well established. We present the case of a 35-year-old male patient with dyspnea and hemoptysis in whom subsequent imaging studies revealed a giant pulmonary artery aneurysm associated with an uncorrected patent ductus arteriosus and Eisenmenger’s syndrome. We chose to treat the patient conservatively with medical management due to the development of Eisenmenger’s physiology while waiting for heart-lung transplantation.

Peripheral mycotic pulmonary artery aneurysms

Mycotic pulmonary artery aneurysms are rare but potentially fatal complications of infective endocarditis. The literature on this rare condition was reviewed and its management is discussed.

Use of endobronchial ultrasonography in the diagnosis of a pulmonary artery aneurysm

We present the case of an 84-year-old man with nonmassive hemoptysis and an obstructing endobronchial mass who was referred for rigid bronchoscopy and biopsy of the lesion. We illustrate how the pulsatile movement of his endobronchial lesion could be differentiated by convex probe endobronchial ultrasound bronchoscopy to be a vascular lesion rather than an endobronchial mass or tumor. Although convex probe endobronchial ultrasonography has many mediastinal applications, it has yet to be used to characterize endobronchial masses. We describe the first case of using convex probe endobronchial ultrasonography in the diagnosis of a left upper lobe pulmonary artery aneurysm presenting as an endobronchial mass.

Pulmonary artery pseudoaneurysm after MRSA septicemia in a pediatric patient

We document a previously unreported case of a pulmonary artery pseudoaneurysm (PAP) that developed in a pediatric patient initially presenting with Methicillin-resistant Staphylococcus aureus hip joint sepsis. This is the first reported case of PAP of infectious origin in a pediatric patient, and this case is unique as the evolution of the PAP was documented by computed tomography.

Percutaneous embolization of an incidentally diagnosed pulmonary aneurysm in a scleroderma patient

A 59-year-old female with history of progressive scleroderma and pulmonary fibrosis was referred for biopsy of a pulmonary nodule that was discovered on computed-tomography (CT) chest surveillance, not present on prior CT- scan. Imaging was suspicious for granuloma, malignancy or aneurysm. CT- Angiography (CTA), performed immediately before the procedure, did not show enhancement of the mass, followed by placement of coaxial-needle into the mass. Suspicion of aneurysm was again raised and repeat CTA demonstrated contrast filling of the aneurysm. With the coaxial-needle in the aneurysm, embolization of the sac was performed using microfibrillar collagen, followed by confirmation of containment and thrombosis with CT.

[Aneurysmal dilatation of pulmonary artery and its branches on mitral stenosis: a case report]

Pulmonary arteries aneurysms are rare and the rarely described bilateral aneurysms. A 45-year-old patient carrier of mitral stenosis was admitted for dyspnoea class III of the NYHA, chest pain and a not infectious cough. The clinical examination found semiology of mitral stenosis, tricuspid incapacity and pulmonary arterial hypertension. The electrocardiogram showed atrial fibrillation and right ventricle hypertrophy. Chest X-ray found a cardiomegaly, an aspect of double outline of the inferior right bow, a prominent aspect of the left average bow reminding an aneurysm of the left pulmonary artery. The echocardiography Doppler found a pure tight mitral stenosis (mitral surface=0.6 cm(2)), a dilation of the trunk of the pulmonary artery (diameter=74 mm) and of its branches (diameter of the right pulmonary artery=28 mm, diameter of the left pulmonary artery=36 mm) seat of a spontaneous contrast. The left atrium and right cardiac cavities were also dilated. There was an important tricuspid incapacity with a major pulmonary hypertension (systolic pulmonary arterial=109 mmHg). The thoracic angioscan showed a pseudoaneurysm of the trunk of pulmonary artery and its branches to their distal parts. Under diuretic, anticoagulating and analgesic treatment the clinical signs improved however the spontaneous contrast persisted. The patient was rejected by the surgery for exceeded clinical board. She is at present followed in our service for 5 months.

Mycotic pulmonary artery aneurysm as a late complication of infective endocarditis after pacemaker implantation

A 49-year-old-woman who had had a pacemaker implanted 15 years earlier became acutely ill with a continuous high fever and general fatigue. A pulmonary artery aneurysm had been rapidly developing and had arrived at the acute phase within 2 weeks. After removal of the pacemaker and with antibiotic therapy the aneurysm gradually decreased in size and has been without rupture for 3 years. Conservative treatment seemed to be sufficient for the management of a mycotic aneurysm in this case.

Congenital and acquired pulmonary artery anomalies in the adult: radiologic overview

Various congenital and acquired anomalies may affect the pulmonary arteries in adult patients. Congenital anomalies (proximal interruption, anomalous origin of the left pulmonary artery [pulmonary artery sling], and idiopathic dilatation of the pulmonary trunk) are usually found incidentally at chest radiography or computed tomography (CT). Acquired anomalies include diffuse or focal enlargement of the arteries because of pulmonary hypertension, aneurysm, and intravascular pulmonary metastasis; decreased arterial diameter because of bronchial carcinoma, mediastinal fibrosis, and Takayasu arteritis; and intraluminal filling defects due to pulmonary thromboembolism and pulmonary artery sarcoma. An awareness of the radiologic manifestations of the disease entities and potential pulmonary artery complications secondary to infection or vasculitis may enable an early diagnosis. CT angiography is becoming the standard method for evaluating patients in whom the presence of pulmonary embolism is suspected. CT assessment of the extent of heart effects in patients with pulmonary hypertension and pulmonary embolism is particularly important because such effects largely determine the prognosis.

Mycotic pulmonary artery aneurysm as an unusual complication of thoracic actinomycosis

Although pulmonary artery aneurysms are a rare vascular anomaly, they are seen in a wide variety of conditions, such as congenital heart disease, infection, trauma, pulmonary hypertension, cystic medial necrosis and generalized vasculitis. To our knowledge, mycotic aneurysms caused by pulmonary actinomycosis have not been reported in the radiologic literature. Herein, a case of pulmonary actinomycosis complicated by mycotic aneurysm is presented. On CT scans, this case showed focal aneurysmal dilatation of a peripheral pulmonary artery within necrotizing pneumonia of the right lower lobe, which was successfully treated with transcatheter embolization using wire coils.

Plain film / MR imaging correlation in heart disease

This article reviews common cardiovascular pathologies that can be noted first on plain film when previously unsuspected, and then illustrates how cross-sectional imaging can provide the follow-up information needed to make a diagnosis. First reviewed are the normal cardiac structures and contours as seen on the plain film of the chest, followed by specific types of pathologies as seen in older adults; patients with lung cancer invading the heart, pericardium, or large vessels; and postsurgical and posttraumatic findings. Also provided is a review of non-cardiac-related areas of plain film and cross-sectional imaging correlation. It is hoped that the reader gains a better understanding and appreciation for the great value of cross-sectional imaging, and the power of the plain film in helping detect and recognize thoracic pathology.

A Mycotic Pulmonary Artery Aneurysm Presenting as an Endobronchial Mass

We report the case of a 49-year-old woman who developed an endobronchial mycotic pulmonary artery aneurysm (PAA) as a complication of pneumonia. After presenting with patchy infiltrates, she developed right lung atelectasis. A noncontrast chest CT scan revealed a mass in the right hilum, and bronchoscopy identified an obstructing lesion in the right mainstem bronchus. Unfortunately, biopsy caused massive hemorrhage, and the patient died. An autopsy identified a mycotic PAA that had invaded the right mainstem. The case suggests that a contrasted CT scan should be included in the evaluation of endobronchial masses and that PAA should be included in the differential diagnosis of such lesions.

Bilateral pulmonary artery aneurysm associated with bilateral pulmonary thromboembolism, superior vena caval thrombosis, and Chagas' disease--a case report

The authors report a case of bilateral pulmonary artery aneurysm in a patient with chronic Chagas' disease and compensated congestive heart failure in whom clinical clues suggested pulmonary thromboembolism, and the actual nature of the lesions was discovered at the time of conventional imaging investigations. This case shows the rarity of bilateral pulmonary aneurysm associated with bilateral pulmonary thromboembolism and the importance of an awareness of this condition in the differential diagnosis for lung masses.