1
|
Maruyama S, Furusawa H, Endo S, Kumagai T, Mitsumura T, Shimada S, Yamana T, Sakakibara R, Iijima Y, Shibata S, Honda T, Shirai T, Okamoto T, Tateishi T, Tamaoka M, Kinowaki Y, Ishibashi H, Okubo K, Miyazaki Y. Pulmonary Artery Aneurysm in a Patient with Nontuberculous Mycobacteria Infection. Intern Med 2024; 63:989-992. [PMID: 37558481 PMCID: PMC11045386 DOI: 10.2169/internalmedicine.2199-23] [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: 04/26/2023] [Accepted: 07/05/2023] [Indexed: 08/11/2023] Open
Abstract
Nontuberculous mycobacterial (NTM) infection sometimes leads to the development of pulmonary artery aneurysm (PAA), a rare but life-threatening complication. We herein report a 64-year-old woman with a history of NTM infection who presented with severe hemoptysis. Computed tomography revealed a ruptured PAA, which was treated successfully with pulmonary artery embolization. Subsequent right total pneumonectomy was performed to control infection. This case emphasizes the need to consider PAA in patients with NTM infection who present with hemoptysis. Early detection and appropriate management are critical for preventing this fatal complication.
Collapse
Affiliation(s)
- Soichi Maruyama
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
- Department of Respiratory Medicine, Nerima Hikarigaoka Hospital, Japan
| | - Haruhiko Furusawa
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Satoshi Endo
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Takashi Kumagai
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Takahiro Mitsumura
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Sho Shimada
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Takashi Yamana
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Rie Sakakibara
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Yuki Iijima
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Sho Shibata
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Takayuki Honda
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tsuyoshi Shirai
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tsukasa Okamoto
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Meiyo Tamaoka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Yuko Kinowaki
- Department of Comprehensive Pathology, Tokyo Medical and Dental University, Japan
| | - Hironori Ishibashi
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Japan
| | - Kenichi Okubo
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| |
Collapse
|
2
|
Khouchoua S, Belkouchi L, Lrhorfi N, El Haddad S, Allali N, Chat L. Mycotic Pulmonary Artery Aneurysm a Rare Complication of Ventricular Septal Defect With Infective Endocarditis: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241238884. [PMID: 38495428 PMCID: PMC10943749 DOI: 10.1177/11795476241238884] [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: 10/29/2023] [Accepted: 02/26/2024] [Indexed: 03/19/2024]
Abstract
Introduction Pulmonary artery aneurysms encompass a wide range of presentations and forms. Mycotic aneurysms represent a particular subset of focal dilatation of the vessel wall with high morbidity and mortality rates. Herein, we report the case of a 32 year old patient, with a prior history of ventricular septal defect presenting with a mycotic pulmonary artery aneurysm associated with infective endocarditis and septic emboli. Case presentation We present the case of a 32 year old male with known history of congenital ventricular septal defect presented to the emergency department with signs of sepsis and dyspnea. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. An echocardiogram found evidence of endocarditis with multiples intra cavitary vegetations. A CT angiogram demonstrated major right ventricular dilatation, multiple nodules and peripheral opacities, scattered throughout the lungs, indicative of septic emboli. Segmental saccular dilatation of the left lateral basal pulmonary artery consistent with a mycotic aneurysm formation was found. The patient was started on intravenous antibiotics and given the overall satisfactory evolution a conservative approach was pursued. The patient was discharged with antibiotics and scheduled for surgical repair of the ventricular septal defect. Conclusion To our knowledge, mycotic aneurysms associated to congenital heart malformation like ventricular septal wall defect remains a rare condition with few reported cases in the literature. Being aware of this entity is important for every practicing radiologist to allow for early diagnosis and treatment.
Collapse
Affiliation(s)
- Selma Khouchoua
- Pediatric Radiology Department, Ibn Sina University Hospital Center, Faculty of medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Lina Belkouchi
- Pediatric Radiology Department, Ibn Sina University Hospital Center, Faculty of medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Najlaa Lrhorfi
- Pediatric Radiology Department, Ibn Sina University Hospital Center, Faculty of medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Siham El Haddad
- Pediatric Radiology Department, Ibn Sina University Hospital Center, Faculty of medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Nazik Allali
- Pediatric Radiology Department, Ibn Sina University Hospital Center, Faculty of medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Latifa Chat
- Pediatric Radiology Department, Ibn Sina University Hospital Center, Faculty of medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| |
Collapse
|
3
|
Li M, Zhu WY, Wu RR, Wang L, Mo MT, Liu SN, Zhu DY, Luo Z. Pulmonary artery aneurysm protruding into the bronchus as an endobronchial mass: A case report. World J Clin Cases 2023; 11:6792-6796. [PMID: 37901013 PMCID: PMC10600857 DOI: 10.12998/wjcc.v11.i28.6792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/11/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Min Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Wen-Ye Zhu
- Department of Pharmacy, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Rong-Rong Wu
- Department of Radiology, The First People’s Hospital of Yunnan Province/Affiliated Hospital of Kunming University of Science and Technology, Kunming 650034, Yunnan Province, China
| | - Le Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Meng-Ting Mo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Shi-Nan Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Dong-Yi Zhu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Zhuang Luo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
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.
Collapse
Affiliation(s)
| | | | | | - Mazen Roumia
- Cardiovascular Medicine, Saint Vincent Hospital, UMass Chan Medical School, Worcester, USA
| |
Collapse
|
6
|
Yukimoto H, Mikami K. Successful Intrasaccular Coil Embolization of Mycotic Pulmonary Artery Pseudoaneurysm Using the Balloon Remodeling Technique. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2022; 7:104-108. [PMID: 36483667 PMCID: PMC9719820 DOI: 10.22575/interventionalradiology.2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/24/2022] [Indexed: 06/17/2023]
Abstract
A 66-year-old man with ventricular septal defect was hospitalized for fever, dyspnea, and hemoptysis. Infectious endocarditis by Streptococcus parasanguinis was suspected. At 3 weeks after admission, massive hemoptysis suddenly occurred. Contrast-enhanced computed tomography showed a 2-cm aneurysmal formation in the right lower pulmonary artery. Rupture of a mycotic pulmonary artery pseudoaneurysm was diagnosed. Pulmonary angiography showed a wide-necked pseudoaneurysm at the trifurcation of the anterior, lateral, and posterior basal segmental arteries of the right lower lobe. Intrasaccular coil embolization with the balloon remodeling technique was successfully performed, preserving residual pulmonary function distal to the pseudoaneurysm.
Collapse
Affiliation(s)
| | - Koji Mikami
- Department of Radiology, Kansai Rosai Hospital, Japan
| |
Collapse
|
7
|
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.
Collapse
|
8
|
Ruwisch J, Fischer B, Häbel L, Laenger F, Bollmann BA. A Case Report and Review of the Literature: Infectious Aneurysm Formation in the Pulmonary Arteries-A Rare but Perilous Sequela of Persisting Infection With Klebsiella pneumoniae. Front Microbiol 2022; 13:893737. [PMID: 35656000 PMCID: PMC9152446 DOI: 10.3389/fmicb.2022.893737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/19/2022] [Indexed: 12/03/2022] Open
Abstract
Septic aneurysms of the pulmonary artery are rare conditions, with few cases having been reported worldwide. They are assumed to result from septic emboli that cause a local inflammatory reaction of the arterial wall, ultimately leading to degenerative changes. We report the case of a 63-year-old female patient presenting with Klebsiella pneumoniae urosepsis and first diagnosis of diabetes mellitus, who developed a life-threatening infectious pulmonary artery aneurysm secondary to bacteremia with Klebsiella pneumoniae. The patient required a lobectomy due to pulmonary hemorrhage. We review the clinical hallmarks of Klebsiella pneumoniae related septic pulmonary embolic disease and summarize currently known risk factors for the development of infectious aneurysmatic disease including diabetes mellitus and other states of immunosuppression. The featured case aims to increase the awareness for this seldom but life-threatening complication of infectious diseases such as Klebsiella pneumoniae urosepsis.
Collapse
Affiliation(s)
- Jannik Ruwisch
- Clinic for Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End Stage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Bettina Fischer
- Clinic for Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End Stage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Lea Häbel
- Clinic for Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Florian Laenger
- Biomedical Research in End Stage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany.,Department of Pathology, Hannover Medical School, Hannover, Germany
| | - Benjamin-Alexander Bollmann
- Clinic for Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End Stage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| |
Collapse
|
9
|
Fong HK, Pinson A, Bhardwaj B, Samad F. Giant high-pressure pulmonary artery aneurysm (PAA) in a patient with COPD and chronic pulmonary embolism (PE). BMJ Case Rep 2022; 15:e245673. [PMID: 35246431 PMCID: PMC8900034 DOI: 10.1136/bcr-2021-245673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/04/2022] Open
Abstract
A woman in her 60s with a history of known severe chronic obstructive pulmonary disease (COPD), former smoker of 50 pack-years and small patent foramen ovale (PFO) without significant shunt was admitted for acute on chronic hypoxic respiratory failure. Diagnostic workup showed severe dilatation of main pulmonary artery (MPA) (75.5 mm axial view and 86.6 mm sagittal view) and left and right PAs measuring 40 mm and 34 mm, respectively, on CT angiography of the chest. Right heart catheterisation showed severe pulmonary hypertension (PH). A diagnosis of giant high-pressure pulmonary arterial aneurysm (PAA) secondary to PH, induced by COPD, and chronic pulmonary embolism was made. Despite aggressive medical management, she passed away on comfort care. Giant high-pressure PAAs are rarely reported. This is a unique case that demonstrates this very rare condition in a living patient. The management of giant PAA is controversial. Experts recommend medical management or aneurysmectomy for sizes of >55-60 mm. Death could have been prevented if our patient was screened earlier and received appropriate medical care.
Collapse
Affiliation(s)
- Hee Kong Fong
- Department of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California, USA
| | - Amber Pinson
- University of Missouri Health Care, Columbia, Missouri, USA
| | | | - Fatima Samad
- University of Missouri Health Care, Columbia, Missouri, USA
| |
Collapse
|
10
|
Kotia S, Adke S, Badhe PV, Rathod K. Pulmonary artery pseudoaneurysm: an unsuspected cause of haemoptysis in Post-COVID fungal infection of the chest. BJR Case Rep 2022; 8:20210198. [PMID: 36177261 PMCID: PMC9499426 DOI: 10.1259/bjrcr.20210198] [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: 10/01/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Pulmonary Artery Pseudoaneurysm (PAP) is a rare but potentially fatal cause of haemoptysis, which often remains unsuspected by both clinicians and radiologists. Traditionally, infections like tuberculosis and bacterial endocarditis have been associated with the development of PAPs. However, additional causative factors like trauma, neoplasia, pulmonary hypertension and vasculitis are also to be considered. With the advent of the novel Coronavirus (COVID-19), attempts have been undertaken to study its multisystem implications. Also, a strong correlation has also been established between COVID-19 and fungal infestation of the paranasal sinuses and lung parenchyma. Hence, PAP should be suspected in post-COVID patients who develop new-onset haemoptysis or new focal consolidation on imaging. Imaging investigations like chest radiograph, CT chest, and CT Pulmonary Angiography help in the establishment of a diagnosis and assessment of the relevant anatomy, which aid in the classification of the PAP. Management strategies include endovascular treatment, surgical resection or conservative approach in form of prolonged antimicrobial therapy. Interventional radiological procedures like endovascular embolisation are especially useful in vitally unstable cases of massive haemoptysis who are poor surgical candidates. Our case highlights the unique presentation of pulmonary arterial pseudoaneurysm induced by a post-COVID-19 fungal infection.
Collapse
Affiliation(s)
- Samvid Kotia
- Department of Radiodiagnosis, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Shrishail Adke
- Department of Radiodiagnosis, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Padma Vikram Badhe
- Department of Radiodiagnosis, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Krantikumar Rathod
- Department of Radiodiagnosis, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| |
Collapse
|
11
|
Verma M, Malhi AS, Kumar S, Agarwala S. An unusual paediatric case of mycotic pulmonary artery aneurysm secondary to staphylococcal skin sepsis. BMJ Case Rep 2022; 15:e247711. [PMID: 35228239 PMCID: PMC8886362 DOI: 10.1136/bcr-2021-247711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amarinder Singh Malhi
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
12
|
Van Hoof L, Verbrugghe P, Jones EAV, Humphrey JD, Janssens S, Famaey N, Rega F. Understanding Pulmonary Autograft Remodeling After the Ross Procedure: Stick to the Facts. Front Cardiovasc Med 2022; 9:829120. [PMID: 35224059 PMCID: PMC8865563 DOI: 10.3389/fcvm.2022.829120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/17/2022] [Indexed: 12/12/2022] Open
Abstract
The Ross, or pulmonary autograft, procedure presents a fascinating mechanobiological scenario. Due to the common embryological origin of the aortic and pulmonary root, the conotruncus, several authors have hypothesized that a pulmonary autograft has the innate potential to remodel into an aortic phenotype once exposed to systemic conditions. Most of our understanding of pulmonary autograft mechanobiology stems from the remodeling observed in the arterial wall, rather than the valve, simply because there have been many opportunities to study the walls of dilated autografts explanted at reoperation. While previous histological studies provided important clues on autograft adaptation, a comprehensive understanding of its determinants and underlying mechanisms is needed so that the Ross procedure can become a widely accepted aortic valve substitute in select patients. It is clear that protecting the autograft during the early adaptation phase is crucial to avoid initiating a sequence of pathological remodeling. External support in the freestanding Ross procedure should aim to prevent dilatation while simultaneously promoting remodeling, rather than preventing dilatation at the cost of vascular atrophy. To define the optimal mechanical properties and geometry for external support, the ideal conditions for autograft remodeling and the timeline of mechanical adaptation must be determined. We aimed to rigorously review pulmonary autograft remodeling after the Ross procedure. Starting from the developmental, microstructural and biomechanical differences between the pulmonary artery and aorta, we review autograft mechanobiology in relation to distinct clinical failure mechanisms while aiming to identify unmet clinical needs, gaps in current knowledge and areas for further research. By correlating clinical and experimental observations of autograft remodeling with established principles in cardiovascular mechanobiology, we aim to present an up-to-date overview of all factors involved in extracellular matrix remodeling, their interactions and potential underlying molecular mechanisms.
Collapse
Affiliation(s)
- Lucas Van Hoof
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verbrugghe
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Jay D. Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States
| | - Stefan Janssens
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Nele Famaey
- Biomechanics Section, KU Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
13
|
Doi A, Gajera J, Niewodowski D, Gangahanumaiah S, Whitford H, Snell G, Kaye D, Joseph T, McGiffin D. Surgical management of giant pulmonary artery aneurysms in patients with severe pulmonary arterial hypertension. J Card Surg 2022; 37:1019-1025. [PMID: 35040512 DOI: 10.1111/jocs.16235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIM Giant aneurysm of the pulmonary artery (PAA) is an extremely rare condition that may develop in patients with pulmonary arterial hypertension (PAH) which may be complicated by rupture, dissection or intravascular thrombus formation. The aim of this study was to examine available literature with regard to surgical strategies in patients undergoing transplantation for PAH with PAA. RESULTS These patients were traditionally considered for heart-lung transplantation but more recently, there have been reports of successful lung transplantation with reconstruction of the pulmonary artery. CONCLUSIONS Unless there is a mandatory indication for heart-lung transplantation, patients with PAH and PAA can undergo lung transplantation and reconstruction of the pulmonary artery without compromising the outcome.
Collapse
Affiliation(s)
- Atsuo Doi
- Department of Cardiothoracic Surgery, Alfred Health, Melbourne, Australia
| | - Jay Gajera
- Department of Cardiothoracic Surgery, Alfred Health, Melbourne, Australia
| | | | | | - Helen Whitford
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Greg Snell
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - David Kaye
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - David McGiffin
- Department of Cardiothoracic Surgery, Alfred Health, Melbourne, Australia
| |
Collapse
|
14
|
Alexis SL, El-Hamamsy I, Robbins MJ. Pulmonary artery aneurysm associated with a nonstenotic bicuspid pulmonic valve: A role for genetics? J Card Surg 2021; 36:4789-4791. [PMID: 34595779 DOI: 10.1111/jocs.16042] [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: 06/30/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bicuspid pulmonic valves are quite uncommon, being described in only 0.1% of donor's hearts, while pulmonary artery aneurysms (PAAs) are even rarer, having been found in 8 out of 109,571 autopsies. This rarity makes it difficult to characterize the relationship between them. MATERIALS AND METHODS We describe the case of a 66-year-old female who was found to have a bicuspid pulmonic valve and PAA (5.1 cm) on imaging by her cardiologist. DISCUSSION AND CONCLUSION This case raises the question of whether the association between bicuspid semilunar valve disease and vascular wall anomalies is more genetic or hemodynamic. Even on the aortic side, despite the robust association between bicuspid aortic valves and thoracic aortic aneurysms, the mechanism still remains unclear. In our patient there was no significant gradient across the bicuspid pulmonic valve, suggesting that hemodynamics are not the primum mobile of this association.
Collapse
Affiliation(s)
- Sophia L Alexis
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Michael J Robbins
- The Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA
| |
Collapse
|
15
|
Tovichien P, Kaeotawee P. Paediatric haemoptysis from multiple pulmonary artery aneurysms. Respirol Case Rep 2021; 9:e0849. [PMID: 34557305 PMCID: PMC8446707 DOI: 10.1002/rcr2.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/22/2021] [Accepted: 09/01/2021] [Indexed: 11/11/2022] Open
Abstract
The case of multiple peripheral pulmonary artery aneurysms in children presenting with haemoptysis following an episode of bacterial endocarditis is presented. They are extremely rare and clinically non-specific but critical because early diagnosis is crucial for preventing sudden death from their rupture. Computed tomography pulmonary angiography remains the investigation of choice. Despite no consensus recommendation on the management, a multidisciplinary team should plan the beneficial approach with minimal procedure-related morbidity and mortality to improve survival. This case report aimed to emphasize the recognition of this rare cause of haemoptysis in children.
Collapse
Affiliation(s)
- Prakarn Tovichien
- Division of Pulmonology, Department of Pediatrics, Faculty of MedicineSiriraj Hospital Mahidol UniversityBangkokThailand
| | - Phatthareeda Kaeotawee
- Division of Pulmonology, Department of Pediatrics, Faculty of MedicineSiriraj Hospital Mahidol UniversityBangkokThailand
| |
Collapse
|
16
|
A Young Man with Massive Hemoptysis and Culture-Negative Endocarditis. Ann Am Thorac Soc 2021; 18:1235-1239. [PMID: 34242146 DOI: 10.1513/annalsats.202009-1108cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
17
|
Huynh R, Morgan L, Yiannikas J. Haemoptysis: just another case of endocarditis? A case report. Eur Heart J Case Rep 2021; 5:ytab226. [PMID: 34263124 PMCID: PMC8274648 DOI: 10.1093/ehjcr/ytab226] [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: 02/05/2021] [Revised: 02/18/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022]
Abstract
Background Pulmonary arteriovenous malformations (PAVM) are rare, and most cases are congenital. They require prompt recognition and management particularly in patients presenting with hypoxia and haemoptysis. We describe a unique case of recurrent endocarditis causing pulmonary artery aneurysms (PAAs) and formation of PAVM. Case summary A 60-year-old woman presented with dyspnoea, haemoptysis, and severe hypoxia. Her background was significant for previous pacemaker lead infection, refractory heart failure secondary to severe tricuspid valve distortion by her pacemaker lead, tricuspid and mitral valve replacements complicated by recurrent endocarditis over several years. Two years prior to her current presentation computed tomography (CT) scanning revealed new small PAAs thought possibly to be mycotic in origin. After her current presentation, prompt high-resolution CT scanning of her chest with contrast revealed significant pulmonary haemorrhage and new clusters of PAVM. Urgent pulmonary angiography confirmed PAVM and was successfully treated with coil embolization. Her dyspnoea, pulmonary haemorrhage, and hypoxia resolved. Discussion Acquired causes account for a very small percentage of PAVM and the mechanism of their development is unknown. As she had recurrent right-sided endocarditis and her PAAs developed following this, with new PAVM developing 2 years later; we hypothesize that they were causally related. We believe this is the first case of recurrent left- and right-sided endocarditis leading to formation of PAAs and development of PAVM presenting with significant hypoxia and haemoptysis requiring prompt intervention.
Collapse
Affiliation(s)
- Ronald Huynh
- Department of Cardiology, Concord Repatriation General Hospital, 1 Hospital Rd, Concord West, New South Wales 2139, Australia
| | - Lucy Morgan
- Department of Respiratory Medicine, Concord Clinical School, Faculty of Medicine, University of Sydney, 1 Hospital Rd, Concord West, New South Wales 2139, Australia
| | - John Yiannikas
- Department of Cardiology, Concord Repatriation General Hospital, 1 Hospital Rd, Concord West, New South Wales 2139, Australia.,Department of Cardiology, Concord Clinical School, Faculty of Medicine, University of Sydney, 1 Hospital Rd, Concord West, New South Wales 2139, Australia
| |
Collapse
|
18
|
Jacob S, Pham AN, Sareyyupoglu B, Pham SM. Bilateral lung transplantation for pulmonary artery aneurysm with severe pulmonary hypertension: An evolution or a revolution? J Card Surg 2021; 36:3000-3002. [PMID: 33993532 DOI: 10.1111/jocs.15654] [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: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
The surgical treatment of pulmonary hypertension (PH), with or without pulmonary artery aneurysm, has evolved during the last 40 years from heart-lung transplants to bilateral lung transplants as the treatment of choice for PH patients with preserved right and left ventricular function and without complex cardiac abnomalies.
Collapse
Affiliation(s)
- Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Anthony N Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
19
|
Kartik K, Mehta CM. Multiple pulmonary artery aneurysms in a young female with patent ductus arteriosus on CT pulomnary angiography. Radiol Case Rep 2021; 16:664-669. [PMID: 33488895 PMCID: PMC7809251 DOI: 10.1016/j.radcr.2021.01.012] [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: 08/29/2020] [Revised: 01/03/2021] [Accepted: 01/03/2021] [Indexed: 11/15/2022] Open
Abstract
Aneurysms of lobar branches of pulmonary artery are extremely rare with few reported cases in literature. The exact etiopathogenesis of pulmonary artery aneurysms is not clearly understood and no clear guidelines on their management is available. Aneurysms of the secondary and tertiary branches appear to be even more uncommon than those of the trunk and primary branches. Here we report an unusual case of young female with multiple pulmonary artery aneurysms in bilateral lungs with fusiform dilation of main pulmonary trunk and a small patent ductus arteriosus.
Collapse
Affiliation(s)
- Krishna Kartik
- Department of Radio-diagnosis, Medical College and S.S.G. Hospital, Vadodara 390006 Gujarat, India
| | - Chetan M Mehta
- Department of Radio-diagnosis, Medical College and S.S.G. Hospital, Vadodara 390006 Gujarat, India
| |
Collapse
|
20
|
Almutairi MD, El-Ghoneimy YA, Alghamdi AO, Alkhamis HA, Altayyar ZA, Houbani KM. Massive Hemoptysis and Recurrent Infective Endocarditis in Intravenous Drug user: A Case Report. J Saudi Heart Assoc 2020; 32:219-223. [PMID: 33154920 PMCID: PMC7640539 DOI: 10.37616/2212-5043.1041] [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: 11/21/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 11/20/2022] Open
Abstract
Intravenous drug use (IDU) poses a high risk of serious complications such as infective endocarditis (IE), which carries high morbidity and mortality rates. Mycotic pulmonary artery aneurysms (MPAA) are rarely associated with right-sided IE, especially in the setting of IDU. It is a potentially fatal complication as it can lead to severe hemorrhage if the aneurysm ruptures. We report the case of a young male with a history of current IDU and tricuspid valve replacement post complicated IE 2 years ago. The patient initially presented with massive hemoptysis and fever. Chest computed tomography (CT) showed a lobulated lesion in the right lower lobe with clear continuation to the pulmonary vessels. We aim to draw attention to the magnitude of complications of active IDU, including massive hemoptysis due to MPAA which should be promptly identified and emergently managed with embolization or surgery, followed by counseling and rehabilitation to minimize the risk of recurrence and save these patients.
Collapse
Affiliation(s)
- Mutlaq Deghaiman Almutairi
- Surgery Division, Department of Surgery, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yasser Ahmed El-Ghoneimy
- Surgery Division, Department of Surgery, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz Omar Alghamdi
- Surgery Division, Department of Surgery, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hashem Abdulkarim Alkhamis
- Surgery Division, Department of Surgery, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ziyad Abdulmohsen Altayyar
- Surgery Division, Department of Surgery, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khalid Mohsen Houbani
- Surgery Division, Department of Surgery, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
21
|
Kang T, Kang MJ. Pulmonary artery pseudoaneurysm showing rapid growth in a patient with lung cancer. Radiol Case Rep 2020; 15:2144-2148. [PMID: 32952752 PMCID: PMC7484516 DOI: 10.1016/j.radcr.2020.07.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022] Open
Abstract
Pulmonary artery pseudoaneurysm is rare and is usually associated with infection. In this report, we describe the case of a patient with pulmonary artery pseudoaneurysm in association with pulmonary squamous cell carcinoma. A 64-year-old man with a previous history of lung cancer showed massive hemoptysis and large consolidation in the right lower lung. Emergency radiologist interpreted this lesion as cancer progression or hematoma. Thus, emergency bronchial and intercostal angiography were performed. However, during admission, the patient presented with another episode of massive hemoptysis. A thoracic radiologist reviewed the previous computed tomography scans and noted the presence of a large hematoma in the right lower lobe of the lung; a pseudoaneurysm was seen within the hematoma arising from the pulmonary artery. On follow up computed tomography, the pseudoaneurysm showed rapid growth. Thus, the patient underwent embolization for the branch of the right lower lobar pulmonary artery using coil and histoacryl. Misdiagnosis of pulmonary artery pseudoaneurysm could be fatal; hence, radiologists should be familiar with the features of pulmonary artery pseudoaneurysm.
Collapse
Affiliation(s)
- Taekyung Kang
- Department of Emergency Medicine, Inje University, Sanggye Paik Hospital, Seoul, South Korea
| | - Mi-Jin Kang
- Department of Radiology, Inje University, Sanggye Paik Hospital, Seoul, South Korea
| |
Collapse
|
22
|
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]
|
23
|
Hamadeh A, Patel NH, Choi JW. Pulmonary Artery Pseudoaneurysm Associated With Abandoned Epicardial Defibrillator Patch. Am J Cardiol 2020; 128:161-162. [PMID: 32650913 DOI: 10.1016/j.amjcard.2020.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022]
Abstract
We describe an 84-year-old man who presented with hemoptysis and acute blood loss anemia due to a pulmonary artery pseudoaneurysm (PAP). The etiology of his PAP was thought to be an abandoned epicardial defibrillator patch that was implanted at age 55. To our knowledge, PAP has never been reported as a possible complication of an abandoned epicardial defibrillator patch.
Collapse
Affiliation(s)
- Anas Hamadeh
- Baylor University Medical Center, Dallas, Texas; Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas.
| | - Nishi H Patel
- Baylor University Medical Center, Dallas, Texas; Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| | - James W Choi
- Baylor University Medical Center, Dallas, Texas; Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| |
Collapse
|
24
|
Abstract
A 73-year-old Japanese man was admitted with an asymptomatic pulmonary artery aneurysm. However, chest X-ray and contrast-enhanced thoracic computed tomography revealed a protrusion at the second left branch that in fact was a pulmonary artery aneurysm with a diameter of 50 mm. Transesophageal echocardiography showed a bicuspid pulmonary valve, and cardiac catheterization revealed pulmonary stenosis with a pressure gradient of 45 mmHg, but no other heart diseases were noted. An extremely rare pulmonary artery aneurysm associated with an isolated bicuspid pulmonary valve was diagnosed.
Collapse
Affiliation(s)
- Seiya Izumida
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Akira Tsuneto
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yoshiyuki Doi
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| |
Collapse
|
25
|
Nuche J, Palomino-Doza J, Ynsaurriaga FA, Delgado JF, Ibáñez B, Oliver E, Subías PE. Potential Molecular Pathways Related to Pulmonary Artery Aneurysm Development: Lessons to Learn from the Aorta. Int J Mol Sci 2020; 21:ijms21072509. [PMID: 32260370 PMCID: PMC7177585 DOI: 10.3390/ijms21072509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare disease caused by pulmonary vascular remodeling. Current vasodilator treatments have substantially improved patients’ survival. This improved survival has led to the appearance of complications related to conditions previously underdiagnosed or even ignored, such as pulmonary artery aneurysm (PAA). The presence of a dilated pulmonary artery has been shown to be related to an increased risk of sudden cardiac death among PAH patients. This increased risk could be associated to the development of left main coronary artery compression or pulmonary artery dissection. Nevertheless, very little is currently known about the molecular mechanisms related to PAA. Thoracic aortic aneurysm (TAA) is a well-known condition with an increased risk of sudden death caused by acute aortic dissection. TAA may be secondary to chronic exposure to classic cardiovascular risk factors. In addition, a number of genetic variants have been shown to be related to a marked risk of TAA and dissection as part of multisystemic syndromes or isolated familial TAA. The molecular pathways implied in the development of TAA have been widely studied and described. Many of these molecular pathways are involved in the pathogenesis of PAH and could be involved in PAA. This review aims to describe all these common pathways to open new research lines that could help lead to a better understanding of the pathophysiology of PAH and PAA and their clinical implications.
Collapse
Affiliation(s)
- Jorge Nuche
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Julián Palomino-Doza
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
| | - Fernando Arribas Ynsaurriaga
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Juan F. Delgado
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Borja Ibáñez
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Eduardo Oliver
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Correspondence: (E.O.); (P.E.S.)
| | - Pilar Escribano Subías
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Correspondence: (E.O.); (P.E.S.)
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Iki Y, Hata A, Fukuyama M, Yoshioka T, Watanabe K, Asari S, Hata D. Successful Conservative Treatment of Mycotic Pulmonary Artery Aneurysms Caused by MRSA Bacteremia. Pediatrics 2019; 144:peds.2019-0672. [PMID: 31624217 DOI: 10.1542/peds.2019-0672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 11/24/2022] Open
Abstract
Mycotic pulmonary artery aneurysms (MPAAs) are rare and life-threatening with currently no recommended treatment strategies. In this report, we describe a successfully treated case of ventricular septal defect in an 11-month-old girl who developed bacteremia, infective endocarditis, and MPAA caused by methicillin-resistant Staphylococcus aureus (MRSA). We first started vancomycin, gentamycin, and panipenem-betamipron for infective endocarditis but switched to teicoplanin and arbekacin on day 3 after initiating treatment because bacteremia persisted, and vancomycin minimum inhibitory concentration was relatively high at 2 mg/L. Although we added clindamycin on day 5 and fosfomycin on day 7, MRSA bacteremia persisted, and we finally added daptomycin at 10 mg/kg per day on day 8, whereupon the bacteremia subsided within a day. Although the bacteremia subsided, the patient developed septic pulmonary embolisms and septic arthritis on her left knee. We continued daptomycin but switched the concomitant drug to linezolid, trimethoprim-sulfamethoxazole, and rifampicin on day 11. After several repeats of puncture and lavage of her knee joint, she became afebrile on day 16. Computed tomography scans taken on day 32 revealed right pulmonary artery MPAAs. She was treated with long-term multidrug therapy, and MPAAs were absent on subsequent computed tomography scans on day 184. Multidrug therapy mainly based on daptomycin could be a possible salvage therapy for refractory MRSA bacteremia with high vancomycin minimum inhibitory concentration. Conservative treatment should be selectively considered as a treatment option for clinically stable MPAA instead of surgical and endovascular treatment.
Collapse
Affiliation(s)
- Yoichi Iki
- Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka City, Osaka, Japan; and
| | - Atsuko Hata
- Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka City, Osaka, Japan; and
| | - Midori Fukuyama
- Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka City, Osaka, Japan; and
| | - Takakazu Yoshioka
- Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka City, Osaka, Japan; and
| | - Ken Watanabe
- Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka City, Osaka, Japan; and
| | - Seishi Asari
- Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Daisuke Hata
- Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka City, Osaka, Japan; and
| |
Collapse
|
28
|
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]
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Benhassen LL, Højsgaard A, Allan Terp K, de Paoli FV. Surgical approach to a mycotic aneurysm of the pulmonary artery presenting with hemoptysis - A case report and a review of the literature. Int J Surg Case Rep 2018; 50:92-96. [PMID: 30092541 PMCID: PMC6086216 DOI: 10.1016/j.ijscr.2018.07.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 11/17/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Leila Louise Benhassen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
| | - Anette Højsgaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Kim Allan Terp
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Frank Vincenzo de Paoli
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, DK-8200, Aarhus N, Denmark; Department of Biomedicine, Aarhus University, Vennelyst Boulevard 4, DK-8000, Aarhus C, Denmark
| |
Collapse
|
32
|
Ishimoto S, Sakurai H, Higure R, Kawachi R, Shimamura M. Pulmonary Artery Pseudoaneurysm Secondary to Lung Inf lammation. Ann Thorac Cardiovasc Surg 2018; 24:154-156. [PMID: 29332925 PMCID: PMC6033521 DOI: 10.5761/atcs.cr.17-00172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary artery aneurysms (PAA) and pseudoaneurysms (PAP) are caused by infections, vasculitis, trauma, pulmonary hypertension, congenital heart disease, and connective tissue disease. Most cases of such aneurysm occur in the trunk or major branches of the pulmonary artery, while the peripheral type is less common. The treatment modalities are medical therapy, surgery, and percutaneous catheter embolization. The mortality rate associated with rupture is approximately 50%. We encountered a case of a 53-year-old man with a pulmonary artery pseudoaneurysm secondary to pneumonia and cavity formation during chemotherapy for acute myeloid leukemia (AML). In diagnosis, contrast-enhanced chest computed tomography (CT) scan and pulmonary angiography were very useful. He was treated with right middle and lower lobectomy. After 1-month follow-up, he could restart additional chemotherapy.
Collapse
Affiliation(s)
- Shinichirou Ishimoto
- Division of Respiratory Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Sakurai
- Division of Respiratory Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Ryouta Higure
- Division of Respiratory Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Riken Kawachi
- Division of Respiratory Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Mie Shimamura
- Division of Respiratory Surgery, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
33
|
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.
Collapse
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
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Pulmonary Artery Pseudoaneurysm: A Rare Cause of Fatal Massive Hemoptysis. Case Rep Pulmonol 2018; 2018:8251967. [PMID: 29850353 PMCID: PMC5937510 DOI: 10.1155/2018/8251967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/15/2018] [Indexed: 11/18/2022] Open
Abstract
Pulmonary artery pseudoaneurysm (PAPA), an uncommon complication of pyogenic bacterial and fungal infections and related septic emboli, is associated with high mortality. The pulmonary artery (PA) lacks an adventitial wall; therefore, repeated endovascular seeding of the PA with septic emboli creates saccular dilations that are more likely to rupture than systemic arterial aneurysms. The most common clinical presentation of PAPA is massive hemoptysis and resultant worsening hypoxemia. Computed tomography angiography is the preferred diagnostic modality for PAPA; typical imaging patterns include focal outpouchings of contrast adjacent to a branch of the PA following the same contrast density as the PA in all phases of the study. In mycotic PAPAs, multiple synchronous lesions are often seen in segmental and subsegmental PAs due to ongoing embolic phenomena. The recommended approach for a mycotic PAPA is prolonged antimicrobial therapy; for massive hemoptysis, endovascular treatment (e.g., coil embolization, stenting, or embolization of the feeding vessel) is preferred. PAPA resection and lobectomy are a last resort, generally reserved for patients with uncontrolled hemoptysis or pleural hemorrhage. We present a case of a 28-year-old woman with necrotizing pneumonia from intravenous drug use who ultimately died from massive hemoptysis and shock after a ruptured PAPA.
Collapse
|
36
|
Karakılıç Ş. Pulmonary Artery Aneurysm. Am J Cardiol 2018. [DOI: 10.1016/j.amjcard.2018.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
37
|
Karakılıç Ş. Pulmonary Artery Aneurysm. Am J Cardiol 2018. [DOI: 10.1016/j.amjcard.2018.03.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
38
|
Knowles KA, Alvin M, Dunn E. Mycotic pulmonary artery aneurysm secondary to septic emboli. BMJ Case Rep 2017; 2017:bcr-2017-223439. [PMID: 29237673 DOI: 10.1136/bcr-2017-223439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Matthew Alvin
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Emily Dunn
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| |
Collapse
|
39
|
Sunagawa K, Uchino Y, Ishimoto S, Nakamura S, Honma T, Nakanishi Y, Hatta Y, Miyazaki Y, Sakurai H, Hao H, Sugitani M. Mycotic pseudoaneurysm of a pulmonary artery branch caused by Cladosporium. Pathol Int 2017; 68:47-52. [PMID: 29193597 DOI: 10.1111/pin.12615] [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: 06/10/2017] [Accepted: 11/04/2017] [Indexed: 11/28/2022]
Abstract
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.
Collapse
Affiliation(s)
- Keishin Sunagawa
- Department of Pathology, Showa University, Shinagawa-ku, Tokyo, Japan.,Department of Pathology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.,Department of Pathology, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan
| | - Yoshihito Uchino
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Shinichirou Ishimoto
- Department of Respiratory Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Shigeki Nakamura
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan
| | - Taku Honma
- Department of Pathology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yoko Nakanishi
- Department of Pathology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yoshihiro Hatta
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan
| | - Hiroyuki Sakurai
- Department of Respiratory Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Hiroyuki Hao
- Department of Pathology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Masahiko Sugitani
- Department of Pathology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| |
Collapse
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Aripoli A, Meek L, Lemons S, Spikes L. A 29-Year-Old Woman With Severe Sepsis and Hemoptysis. Chest 2017; 150:e53-7. [PMID: 27502994 DOI: 10.1016/j.chest.2016.02.681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/16/2016] [Accepted: 02/25/2016] [Indexed: 10/21/2022] Open
Abstract
A 29-year-old woman presented with a 1-week history of fever, weakness, anorexia, darkened urine, and mild cough. The patient described her cough as nonproductive and without hemoptysis. She had no chest pain. The patient's medical history was significant for x-linked hypophosphatemia, renal stones, migraine headaches, and chronic back pain managed on prescribed oral opiates for some time. She reported regular cigarette smoking, but denied illicit or IV drug use or any recent travel or sick contacts. The patient also had no known pertinent family history.
Collapse
Affiliation(s)
- Allison Aripoli
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS.
| | - Lucas Meek
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS
| | - Steven Lemons
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS
| | - Leslie Spikes
- Department of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, KS
| |
Collapse
|
42
|
Anesthesia for pulmonary trunk aneurysmorrhaphy. Braz J Anesthesiol 2016; 67:95-99. [PMID: 28017178 DOI: 10.1016/j.bjane.2013.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 03/22/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aneurysm in the pulmonary trunk is a rare disease. Because of its location, a rupture can lead to right ventricular failure and sudden death. Aneurysmorraphy is the most widely used surgical treatment in these cases. The aim of this study is to report a successful balanced general anesthesia for aneurysmorraphy of pulmonary trunk. CASE REPORT Male patient, 28 years, asymptomatic, diagnosed with an aneurysm in the pulmonary trunk. According to the location of the aneurysm and the consequent failure of the pulmonary valve, an aneurysmorraphy was indicated, with implantation of vascular-valvular prosthesis (valved tube). We opted for a balanced general anesthesia, seeking to prevent an increase in systemic and pulmonary vascular resistances, thus avoiding to cause stress on the wall of the aneurysmal vessel. CONCLUSIONS A balanced general anesthesia, in combination with adequate ventilation to prevent elevation in pulmonary vascular pressure, was appropriate for surgical repair of an aneurysm in the pulmonary trunk.
Collapse
|
43
|
João BB, Bueno RM, Marques GD, Soares FB. [Anesthesia for pulmonary trunk aneurysmorrhaphy]. Rev Bras Anestesiol 2016; 67:95-99. [PMID: 28017189 DOI: 10.1016/j.bjan.2013.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 03/22/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aneurysm in the pulmonary trunk is a rare disease. Because of its location, a rupture can lead to right ventricular failure and sudden death. Aneurysmorraphy is the most widely used surgical treatment in these cases. The aim of this study is to report a successful balanced general anesthesia for aneurysmorraphy of pulmonary trunk. CASE REPORT Male patient, 28 years, asymptomatic, diagnosed with an aneurysm in the pulmonary trunk. According to the location of the aneurysm and the consequent failure of the pulmonary valve, an aneurysmorraphy was indicated, with implantation of vascular-valvular prosthesis (valved tube). We opted for a balanced general anesthesia, seeking to prevent an increase in systemic and pulmonary vascular resistances, thus avoiding to cause stress on the wall of the aneurysmal vessel. CONCLUSIONS A balanced general anesthesia, in combination with adequate ventilation to prevent elevation in pulmonary vascular pressure, was appropriate for surgical repair of an aneurysm in the pulmonary trunk.
Collapse
Affiliation(s)
- Benedito Barbosa João
- Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil; Hospital Beneficência Portuguesa, São Paulo, SP, Brasil; Hospital Euryclides de Jesus Zerbini, São Paulo, SP, Brasil.
| | - Ronaldo Machado Bueno
- Hospital Beneficência Portuguesa, São Paulo, SP, Brasil; Instituto do Coração do Hospital das Clínicas - Incor (FMUSP), São Paulo, SP, Brasil
| | | | | |
Collapse
|
44
|
Kumar R, Wales CJ, Fisher M. Pulmonary Artery Aneurysm Presenting as Solitary Pulmonary Nodule. Scott Med J 2016. [DOI: 10.1258/rsmsmj.51.2.54e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- R Kumar
- Department of Diabetology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
| | - CJ Wales
- Department of Diabetology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
| | - M Fisher
- Department of Diabetology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
| |
Collapse
|
45
|
Utility of endovascular embolisation in management of peripheral pulmonary artery aneurysms. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
46
|
Abstract
OBJECTIVE The purpose of this study was to analyze the clinical and CT features of pulmonary artery pseudoaneurysms (PAPs). MATERIALS AND METHODS A database search of chest CT examinations performed from January 1, 2000 to December 31, 2014 identified 24 patients with findings consistent with PAPs. A CT finding consistent with a PAP was defined as a focal saccular outpouching of a pulmonary artery. Medical records were reviewed to determine clinical presentations, treatments, and outcomes. CT scans were reviewed by two board-certified fellowship-trained chest radiologists. RESULTS A total of 35 PAPs were identified in 24 patients. Hemoptysis and shortness of breath were the most common presenting symptoms. The most commonly identified causes of PAPs were infection (33%), neoplasms (13%), and trauma (17%). Of the 35 PAPs, 29 (83%) were located in segmental or subsegmental pulmonary arteries. A solitary PAP was identified in 20 (83%) patients, and multiple PAPs were identified in three patients with endocarditis and one patient with pulmonary metastases. Only three of 35 (9%) PAPs were associated with a ground-glass halo. Endovascular treatment was successfully performed in 12 patients, and only one patient had immediate recurrent hemoptysis after treatment. PAP was clinically suspected by the referring clinicians in only three patients. Sixteen of the 35 (46%) PAPs were not reported on the initial CT studies. CONCLUSION PAPs showed a strong predilection for the peripheral pulmonary arteries. Multiplicity of PAPs can be seen in the settings of endocarditis and pulmonary metastatic disease. Most PAPs were not associated with a ground-glass halo. PAPs can be lethal but were often not suspected clinically and were underreported by radiologists.
Collapse
|
47
|
Dixon J, Wilkinson H, Iqbal K, Quan V. Recurrent anti-GBM disease with pulmonary artery aneurysms. JRSM Open 2016; 7:2054270416640154. [PMID: 27688893 PMCID: PMC5011304 DOI: 10.1177/2054270416640154] [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: 11/17/2022] Open
Abstract
We present the first known case of pulmonary artery aneurysms as a feature of Recurrent Anti-Glomerular Basement Membrane disease.
Collapse
Affiliation(s)
- John Dixon
- South West Thames Renal and Transplantation Unit, St. Helier University Hospital, Carshalton, Surrey, UK
| | - Hannah Wilkinson
- South West Thames Renal and Transplantation Unit, St. Helier University Hospital, Carshalton, Surrey, UK
| | - Kamran Iqbal
- South West Thames Renal and Transplantation Unit, St. Helier University Hospital, Carshalton, Surrey, UK
| | - Virginia Quan
- South West Thames Renal and Transplantation Unit, St. Helier University Hospital, Carshalton, Surrey, UK
| |
Collapse
|
48
|
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
| |
Collapse
|
49
|
Theerman IL, Choi M, Fowler A, Copeland H, Heimes J, Hasaniya N, Deisch J, Wallen JM, Zaheer S. Post traumatic pulmonary pseudoaneurysm requiring pneumonectomy: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:242. [PMID: 27429968 DOI: 10.21037/atm.2016.06.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 57-year-old male presented with progressive exertional dyspnea, cough, and hemoptysis. He underwent a chest computed tomography (CT) that demonstrated a 27 cm × 20 cm right chest mass that was causing a local mass effect. Pertinent history revealed that the patient had suffered a severe chest trauma from a MVA in 1981. The patient underwent workup including: needle localized biopsy, bronchoscopy and endoscopic biopsy. There was considerable concern for a malignant process and a subsequent right pneumonectomy with en bloc resection of the chest wall and diaphragm was performed. The final pathology concluded the mass to be a large pseudoaneurysm. Pseudoaneurysms after traumas are extremely rare, especially blunt trauma, and should be considered once other etiologies have been excluded.
Collapse
Affiliation(s)
- Isaac L Theerman
- Department of Surgery, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Mark Choi
- Department of Surgery, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Aaron Fowler
- Department of Surgery, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Hannah Copeland
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Jessica Heimes
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Nahidh Hasaniya
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Jeremy Deisch
- Department of Pathology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Jason M Wallen
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Salman Zaheer
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| |
Collapse
|
50
|
Numano F, Shimizu C, Tremoulet AH, Dyar D, Burns JC, Printz BF. Pulmonary Artery Dilation and Right Ventricular Function in Acute Kawasaki Disease. Pediatr Cardiol 2016; 37:482-90. [PMID: 26681305 DOI: 10.1007/s00246-015-1303-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
Coronary artery inflammation and aneurysm formation are the most common complications of Kawasaki disease (KD). Valvulitis and myocarditis are also well described and may lead to valvar regurgitation and left ventricular dysfunction. However, functional changes in the right heart have rarely been reported. We noted several acute KD patients with dilated pulmonary arteries (PA) and thus sought to systematically characterize PA size and right-heart function in an unselected cohort of KD patients cared for at a single clinical center. Clinical, laboratory, and echocardiographic data from 143 acute KD subjects were analyzed. PA dilation was documented in 23 subjects (16.1 %); these subjects had higher median right ventricle myocardial performance index (RV MPI), higher ratio of early tricuspid inflow velocity to tricuspid annular early diastolic velocity (TV E/e'), and lower median TV e' velocity compared to the non-PA dilation group (0.50 vs 0.38 p < 0.01, 4.2 vs 3.6 p < 0.05, and 13.5 vs 15.2 cm/s p < 0.01, respectively). Almost all subjects with PA dilation had improved PA Z-score, RV MPI, and TV E/e' in the subacute phase (p < 0.01). There were no significant differences in indices of left ventricle function between PA dilation group and non-PA dilation group. In summary, PA dilation was documented in 16 % of acute KD subjects. These subjects were more likely to have echocardiographic indices consistent with isolated RV dysfunction that improved in the subacute phase. The long-term consequence of these findings will require longitudinal studies of this patient population.
Collapse
Affiliation(s)
- Fujito Numano
- Departments of Pediatrics, San Diego School of Medicine, University of California, San Diego, USA. .,Department of Pediatrics, UCSD School of Medicine, Kawasaki Disease Research Center, 9500 Gilman Dr., La Jolla, CA, 92093-0641, USA.
| | - Chisato Shimizu
- Departments of Pediatrics, San Diego School of Medicine, University of California, San Diego, USA
| | - Adriana H Tremoulet
- Departments of Pediatrics, San Diego School of Medicine, University of California, San Diego, USA.,Rady Children's Hospital San Diego, San Diego, USA
| | - Dan Dyar
- Rady Children's Hospital San Diego, San Diego, USA
| | - Jane C Burns
- Departments of Pediatrics, San Diego School of Medicine, University of California, San Diego, USA.,Rady Children's Hospital San Diego, San Diego, USA
| | | |
Collapse
|