Pulmonary artery aneurysm: review and case report

Pulmonary artery aneurysm caused by infective endarteritis attributed to patent ductus arteriosus in children: a case report and literature review

We report a case of a 10-year-old male patient with pulmonary artery aneurysm (PAA) caused by infective endarteritis of the pulmonary artery attributed to patent ductus arteriosus. He was found to have patent ductus arteriosus at the age of 2, but he was not treated because of the absence of symptoms and normal physical development. He sought medical attention for fever and cough in August 2022. Echocardiography showed pulmonary artery aneurysm, intrapulmonary artery bulge, patent ductus arteriosus, and pericardial effusion. Contrast-enhanced CT showed pulmonary artery aneurysm, patent ductus arteriosus, and a slight compression of the left main bronchus. Surgery was performed to reconstruct the main pulmonary trunk and repair the ductus arteriosus in November 2022. The surgical outcomes were satisfactory.

Endovascular Plug for Endobronchial Management of an Expectorated Pulmonary Artery Embolization Coil: A Case Report

Pulmonary artery aneurysms are frequently managed with endovascular embolization. Rare but serious complications of coil embolization are erosion and migration of the coils into the adjacent airways, posing a risk for massive hemoptysis. We report the case of a medically complex patient with a left main pulmonary artery aneurysm treated with coil embolization who ultimately experienced transbronchial migration and expectoration of the coil. We discuss the challenging anesthetic and surgical management of these serious complications, including the use of an endovascular plug to occlude the erosion site and distal airways.

Case Report: Two Cases of Pulmonary Artery Dissection in Young Infants

Pulmonary artery dissection (PAD) is a rare disease. This article reports the treatment of PAD in young infants for the first time. Both cases of the infants were treated with surgery. Different surgical methods achieve different results, which provide ideas for treating PAD in young infants.

The Biofabrication of Diseased Artery In Vitro Models

As the leading causes of global death, cardiovascular diseases are generally initiated by artery-related disorders such as atherosclerosis, thrombosis, and aneurysm. Although clinical treatments have been developed to rescue patients suffering from artery-related disorders, the underlying pathologies of these arterial abnormalities are not fully understood. Biofabrication techniques pave the way to constructing diseased artery in vitro models using human vascular cells, biomaterials, and biomolecules, which are capable of recapitulating arterial pathophysiology with superior performance compared with conventional planar cell culture and experimental animal models. This review discusses the critical elements in the arterial microenvironment which are important considerations for recreating biomimetic human arteries with the desired disorders in vitro. Afterward, conventionally biofabricated platforms for the investigation of arterial diseases are summarized, along with their merits and shortcomings, followed by a comprehensive review of advanced biofabrication techniques and the progress of their applications in establishing diseased artery models.

Successful embolization of an infected aneurysm of a subsegmental pulmonary artery in an infant with necrotizing MRSA pneumonia

Para-infections aneurysms are a very rare complication but bear the risk of significant morbidity and mortality in case of rupture and hemorrhage. We present the youngest published case of a right-sided pulmonary artery pseudoaneurysm due to nonmultiresistant Staphylococcus aureus pneumonia in a 7-month old boy, complicated by 2 episodes of significant hemorrhage. Selective microvascular plug embolization of the feeding segmental pulmonary artery by interventional radiology and cardiology was successfully undertaken while having a cardiothoracic surgical team on stand-by. Follow-up ultrasounds showed no residual flow distal to the microvascular plug. The patient had complete clinical recovery 10 months after the initial presentation. Interventional radiology procedures are challenging in children due to limited availability of appropriately-sized equipment, low case numbers, and a limited body of literature.

Pulmonary artery aneurysms: Preoperative, intraoperative, and postoperative findings

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.

Minimally Invasive Pulmonary Artery Aneurysm Repair Through a Left Anterior Minithoracotomy-an Alternative Approach

The purpose in this case was to repair a less invasive approach than a standard sternotomy. Workup of asymptomatic patient with computerized tomography scan of chest revealed pulmonary artery aneurysm and transesophageal echocardiography demonstrated flow stagnation in aneurysm. An alternative minimally invasive approach was performed to repair the pulmonary artery aneurysm with plication through a left anterior minithoracotomy using normothermic cardiopulmonary bypass with percutaneous peripheral cannulation, instead of median sternotomy. Post-repair transesophageal echocardiography demonstrated normal flow in the pulmonary artery. The patient had an uneventful postoperative course and was seen in the outpatient clinic with excellent recovery. Minimally invasive repair of pulmonary artery aneurysm through a left anterior minithoracotomy is a feasible alternative approach. Minimally invasive repair of pulmonary artery aneurysm through a left anterior minithoracotomy is a feasible alternative approach.

A Rare Combination of Congenitally Corrected Transposition of the Great Arteries with Pulmonary Artery Aneurysm

•ccTGA can be unnoticed until advanced age. •ccTGA is rarely associated with an ASD and a large PA aneurysm. •Mesocardia may accompany this complex congenital heart disease. •SAVV regurgitation is a common finding.

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

BACKGROUND

Acquired peripheral or intraparenchymal pulmonary artery aneurysms (PPAA) are rare entities but are important to recognize because of the associated morbidity. Hemoptysis is their principal complication and is a potentially fatal condition.

PURPOSE

To illustrate the causes, multidetector CT angiography (MDCTA) findings and differential diagnosis of acquired PPAA.

MATERIALS AND METHODS

The institutional review boards approved this study. We conducted a retrospective review of the demographic data and the results of clinical and laboratory examinations, and imaging studies of patients managed between January 2012 and January 2017 in two institutions.

RESULTS

A total of 19 patients had acquired PPAA that were detected at MDCTA, 9 patients with normal pulmonary artery pressures and 10 with pulmonary hypertension. Nine patients developed PPAA-related acute symptoms. MDCTA features of PPAA include: a lobulated vascular mass, an indistinct irregular arterial wall, aneurysmal thrombosis or wall calcification, findings of impending rupture including perianeurysmal edema, gas or a soft tissue mass.

CONCLUSION

PPAA are rare. In our series, endocarditis and pulmonary hypertension are the PPAA leading causes. The treatment modality preferred is embolization, especially as surgery poses a very high risk for patients with severe pulmonary hypertension. Further clarification of the natural history of these rare arterial aneurysms is needed.

Acute and chronic dissection of pulmonary artery: new challenges in pulmonary arterial hypertension?

Right ventricular failure is a leading cause of mortality in patients with pulmonary arterial hypertension (PAH). However, up to 25% of such patients die unexpectedly, without warning signs of hemodynamical decompensation. We previously documented that pulmonary artery (PA) dilatation significantly increases the risk of those deaths. Some of them may be due to dissection of PA resulting in cardiac tamponade. However, direct confirmation of this mechanism is difficult as most of such deaths occur outside hospitals. We present 4 patients with severe PAH and PA dilatation in whom PA dissection has been confirmed. Three patients had IPAH, one had PAH associated with congenital heart disease. All patients had mean pulmonary artery pressure (PAP) > 50 mmHg at diagnosis and dissection occurred late in the course of apparently well controlled disease (6 to 14 years). Several clinical elements were common to our patients - high systolic PAP, long lasting PH, progressive dilatation of PA to more than 50 mm with chest pain prior to dissection. However, clinical course followed three different patterns: sudden death due to cardiac tamponade, hemopericarditis caused by blood leaking from dissected aneurysm with imminent but not immediate cardiac tamponade, or chronic asymptomatic PA dissection. Indeed, two of our patients are alive and on lung transplantation waiting list for more than 2 years now. Further research is needed to suggest optimal management strategies for patients with stable PAH but significantly dilated proximal pulmonary arteries or confirmed PA dissection depending on the clinical presentation and expected outcome.

Bilateral multiple pulmonary artery aneurysms associated with cavitary pulmonary tuberculosis: a case report

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.

Huge idiopathic pulmonary artery aneurysm

A pulmonary artery aneurysm is an uncommon anomaly. The clinical manifestations are mostly nonspecific, and management is controversial. We report a case of a 67-year-old woman with a main pulmonary artery aneurysm who did not take surgical intervention. Subsequently, there was no increase in size for 3 years.

Mucormycosis causing pulmonary artery aneurysm

Pulmonary artery aneurysm (PAA) is an uncommon entity and is usually congenital in origin or secondary to pulmonary arterial hypertension. Infections causing PAA are few, tuberculosis and bacterial infections being the common causative organisms. There have been few cases reported previously, in which the organism causing PAA was found to be a rare fungus called mucor. Pulmonary mucormycosis causing PAA is an infrequent and almost fatal complication as most of the diagnosis was made post mortem. This report brings out a case of pulmonary mucormycosis causing ruptured PAA in a patient with diabetes. This patient was cured by a timely treatment of a combination of surgery and medical therapy.

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

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

Innovative endovascular technique for treatment of rare cause of haemoptysis in young

A 17-year-old boy reported for evaluation of two episodes of massive haemoptysis. His clinical examination was unremarkable and investigations (haemogram, coagulogram, serological tests for connective tissue disorders) were normal. A 64-slice CT angiography revealed a saccular aneurysm of 3.8×3.7×3.3 cm arising from the right lower lobe pulmonary artery which was confirmed by cardiac catheterisation. The aneurysm was successfully blocked with a 16-14 Amplatzer duct occluder. A repeat CT angiogram performed after 15 days revealed the device in situ obliterating the aneurysm. Pulmonary artery aneurysm is an extremely rare cause of massive haemoptysis and indicates imminent rupture of the aneurysm which can be rapidly fatal. This case highlights the importance of using an innovative endovascular technique for treatment of a rare cause of haemoptysis.

Ruptured pulmonary artery aneurysm: a surgical emergency

Idiopathic pulmonary artery aneurysm rupture was diagnosed in a 79-year-old man who presented with a dry cough. He was considered unlikely to tolerate extensive pulmonary artery reconstruction or lung resection; hence, he was salvaged by timely ligation of the distal pulmonary artery at the origin of the aneurysm.

Mycotic pulmonary artery aneurysm due to Aspergillus infection in a patient with leukemia: case report and review of the literature

We present a case of a patient with hairy cell leukemia and pulmonary aspergillosis who developed a cycotic pulmonary artery aneurysm despite prolonged antifungal therapy. A review of the literature in regards to incidence, etiology, clinical manifestations and treatment options is included.

Idiopathic pulmonary artery dissection: a case report

Introduction

The occurrence of pulmonary artery dissection is extremely rare in patients without pulmonary hypertension, congenital cardiac abnormalities or cardiac intervention. A diagnosis of pulmonary artery dissection is rarely made during life because it generally leads to cardiogenic shock and sudden death. The progression or natural course of pulmonary artery dissection is not known and the optimum management is not defined because of the paucity of cases in the literature.

Case presentation

We report a rare case of a 51-year-old female patient, without pulmonary hypertension or other cardiac abnormalities, who presented with acute chest pain and was found to have a pulmonary artery dissection.. The diagnosis of pulmonary artery dissection was confirmed by computed tomography scan of the chest and cardiac magnetic resonance imaging. The patient declined surgical intervention and was followed up closely with medical therapy. At almost a year after her initial presentation, the patient is stable with no complications.

Conclusions

To our knowledge, there are no similar cases reported in the literature of people with pulmonary artery dissection who have been followed up and who have not had surgical intervention. We review the etiology, pathophysiology, clinical associations, diagnosis and management of patients with pulmonary artery dissection.

A giant main pulmonary artery aneurysm associated with infundibular pulmonary stenosis

We report a case of a giant pulmonary artery aneurysm associated with infundibular pulmonary stenosis. Echocardiography disclosed markedly enlarged main pulmonary artery, but no left to right shunt flow at levels of the atrial septum, ventricular septum and the pulmonary artery. Continuous wave Doppler revealed a maximum velocity of 1.5 m/s which corresponded to the pressure gradient between the right ventricle and the pulmonary artery of 9.5 mmHg. Contrast-enhanced multidetector-row computed tomography with a 16-slice scanner revealed pulmonary artery aneurysm with the maximum diameter of 67 mm on axial image.

Idiopathic pulmonary artery aneurysm

A case of idiopathic pulmonary artery aneurysm is presented along with a review of our experience of this rare condition. These entities may have an association with cystic medial degeneration of the arterial wall and are subject to the same complications as aortic aneurysms.

Pulmonary artery dissection: an emerging cardiovascular complication in surviving patients with chronic pulmonary hypertension

Pulmonary arterial dissection is an extremely rare and usually lethal complication of chronic pulmonary hypertension. The condition usually manifests as cardiogenic shock or sudden death and is therefore typically diagnosed at postmortem examination rather than during life. However, recent isolated reports have described pulmonary artery dissection in surviving patients. The first case of pulmonary artery dissection in a surviving patient with cor pulmonale caused by chronic obstructive pulmonary disease is presented. The aetiology, pathophysiology, and clinical presentation of pulmonary artery dissection are reviewed and factors that may aid diagnosis during life are discussed.

Transesophageal echocardiographic detection of a pulmonary artery aneurysm complicated by thrombus

The incidence of aneurysms of the pulmonary artery is known to be very low. Although diagnosis and evaluation of pulmonary artery aneurysms may be difficult without angiography, computed tomography and MRI's have emerged as useful noninvasive techniques. However, a transthoracic echocardiogram may reveal a pulmonary artery aneurysm. To our knowledge, transesophageal echocardiographic findings of pulmonary artery aneurysm with thrombus have not been reported in detail. Here, a case of thrombosed aneurysm of the main pulmonary artery diagnosed by transesophageal echocardiography and confirmed by computed tomography and MRI is reported.

A case of pulmonary artery dissection diagnosed in the Emergency Department

Pulmonary artery dissections typically occur at the site of a pulmonary artery aneurysm associated with pulmonary hypertension or connective tissue disease. Dyspnea on exertion, retrosternal chest pain, central cyanosis, and sudden hemodynamic decompensation are the four main clinical signs and symptoms associated with a pulmonary artery dissection. Diagnosis of a pulmonary artery dissection frequently occurs postmortem, as many of these patients experience sudden death when the main pulmonary artery dissects into the pericardium, causing acute cardiac tamponade. Pulmonary artery dissection has been diagnosed in living patients using transthoracic echocardiogram, computed tomography (CT) scanning, magnetic resonance imaging (MRI), and angiography. Surgery is curative. Emergency physicians should consider the diagnosis of pulmonary artery dissection in patients presenting with either retrosternal chest pain, dyspnea on exertion, central cyanosis, or sudden hemodynamic decompensation and who have a past medical history of pulmonary hypertension, pulmonary artery surgery, or a disease causing chronic inflammation of myocardial or vascular tissue.

Successful balloon valvuloplasty in an adult patient with severe pulmonic stenosis and aneurysmal poststenotic dilatation

We present a case of pulmonic stenosis with large aneurysmal poststenotic dilatation that was safely and effectively treated with balloon valvuloplasty. Though the poststenotic dilatation persists after the procedure, the risk of dissection and rupture is very low. Hence, balloon valvuloplasty should be considered the treatment of choice in this setting.

Pulmonary artery dissection in patients without underlying pulmonary hypertension

AIMS

Pulmonary artery (PA) dissection is a rare event which usually occurs in patients with underlying pulmonary hypertension. We describe two patients who developed PA dissection without pre-existing pulmonary hypertension and present an extensive review of the literature.

METHODS AND RESULTS

In the first patient (a 59-year-old woman), acute-onset dyspnoea was initially thought to have been caused by pulmonary thrombosis, and thromboendarterectomy was performed. Histologically, pulmonary dissection without external rupture was evident, chiefly in the right main PA. In the second patient, an 85-year-old man who had hypergammaglobulinaemia of unknown cause and died from a haemorrhagic gastric ulcer, arterial dissection was detected at autopsy. There was no underlying pulmonary hypertension in either patient. Although the true reason for the development of dissection is unclear, pre-existing inflammation was considered to be related to its formation, at least in the second case.

CONCLUSIONS

A literature review indicated that idiopathic and inflammation-related PA dissection is extremely unusual. Since PA dissection is very rare, it is important to be aware of its features in order to make a correct diagnosis.

Surgical repair of the pulmonary trunk aneurysm

OBJECTIVE

Aneurysm formation of the pulmonary trunk is rare and there is controversy about optimal treatment for this disease. The aim of this article is to report four patients with pulmonary trunk aneurysm which were managed by surgical repair.

MATERIALS AND METHODS

From 1986 to 1997, we performed surgical repair for pulmonary trunk aneurysm in four patients. There was one male and three female patients with a mean age of 63.3 years (range: 54-78 years). Concomitant diseases were cardiac valvular disease in four patients, thoracic aortic dissection in two, atherosclerotic abdominal aortic aneurysm in two, and coronary artery disease in one. All patients were in New York Heart Association functional class III preoperatively. Surgical procedures for the pulmonary trunk aneurysm included Dacron graft replacement in two patients and aneurysmorrhaphy in two. Associated procedures were cardiac valvular operation in three patients with four lesions and right ventricular outflow tract reconstruction (RVOTR) in one.

RESULTS

There were no operative mortalities and no late deaths with a mean follow-up period of 6.6 years (range: 2.4-10.0 years). One female patient developed recurrent pulmonary trunk aneurysm 9.5 years after aneurysmorrhaphy, and underwent a second operation where Dacron graft replacement of the aneurysm including pulmonary valve replacement was performed successfully. All patients are now leading normal lives.

CONCLUSIONS

Surgical management should be considered for large aneurysm of the pulmonary trunk regardless of its etiology and underlying disease to prevent possible rupture with fatal result if the patient has an acceptably low operative risk.

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

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

Acute pulmonary trunk dissection in a patient with primary pulmonary hypertension

Spiral CT imaging findings including multiplanar reconstructions of an acute dissection of the pulmonary trunk in a 22-year-old female patient with primary pulmonary hypertension (PPH) are presented and discussed.

Pulmonary artery aneurysm

Main pulmonary artery aneurysm is an exceedingly rare entity. We present a case of main pulmonary artery aneurysm with patent ductus arteriosus in a sixty-year-old woman. The aneurysm was successfully treated with aneurysmectomy and primary anastomosis of the defect of the main pulmonary artery, and the patent ductus arteriosus was divided. The etiology, operative indication and surgical intervention of main pulmonary artery aneurysm are discussed along with a review of the literature.