Aneurysm of the Pulmonary Vein: An Unusual Cause of Stroke

Rare and potentially lethal case of a round lesion in the lung

A pulmonary venous aneurysm (PVA) is extremely rare. A PVA can be either congenital or acquired. Possible symptoms include thoracic pain, dyspnoea, haemoptysis and palpitations but can also occur asymptomatically. Treatment can be conservative or surgical depending on growth and risk of rupture or development of mitral insufficiency, symptoms and thrombus formation. Only a few cases have been described in the literature. A recent case study and a literature review are described below.

A lung cyst harbouring a congenital pulmonary varix

A non-smoker man in his second decade presented to a medical centre with intermittent haemoptysis over 2 years. The haemoptysis was infrequent initially to be ignored, but later, the episodes increased in amount and frequency. Routine blood tests including coagulation profile showed normal results. The chest radiography and echocardiography were normal. The contrast-enhanced CT scan of the chest showed a cystic lesion with intracystic abnormality and surrounding ground-glass opacity in the left upper lobe. The CT pulmonary angiography and invasive pulmonary angiography showed the abnormality to be a dilated pulmonary vessel draining into the left atrium, thereby confirming the diagnosis of congenital pulmonary varix contained within a lung cyst. The patient underwent a successful lobectomy following which he experienced no further haemoptysis.

A Diagnostic Conundrum: Progressive Tubular Lung Mass in Asymptomatic Young Woman

CASE PRESENTATION

A 39-year-old female avid marathon runner presented with an abnormal chest radiograph obtained during preoperative evaluation prior to bilateral knee replacement because of osteoarthritis. As shown in Figure 1, chest radiograph revealed a focal nodular opacity in the middle lobe. She did not have any prior imaging for comparison.

Pulmonary venous varix associated with mitral regurgitation mimicking a mediastinal mass: A case report and review of the literature

Pulmonary vein varix is an unusual cause of a mediastinal mass on a chest radiograph. It may be found as an isolated malformation or as a sequela of pulmonary venous hypertension. We encountered a case presenting with left hemiparesis and a past medical history of rheumatic heart disease. The chest radiograph revealed a well-defined mediastinal mass that turned out to be a hugely dilated pulmonary vein on contrast enhanced computed tomography of the chest. The computed tomography of the brain and upper abdomen revealed bilateral cerebral infarction and splenic infarction. In the literature, one-third of the reported cases of pulmonary vein varix are acquired secondary to mitral valve disease.

Generalized Malperfusion Due to Systemic Embolization From a Large Thrombosed Pulmonary Vein Aneurysm

We report the case of a 61-year-old patient who presented with generalized malperfusion due to systemic embolization from a large, partially thrombosed aneurysm of the left upper pulmonary vein. When the patient arrived at our center, large thrombus formations were detected in the left atrium and the abdominal aorta, as well as the renal, iliac, and femoral arteries. Renal, splenic, and mesenteric ischemia was diagnosed with computed tomography. The patient was in shock, acute kidney failure, and in high vasopressor need. The case highlights the risk of intraluminal thrombus formation in pulmonary vein aneurysms and underlines the need for systemic anticoagulation therapy and surgical therapy, if diagnosed in time.

Management of asymptomatic pulmonary vein aneurysm

Aneurysm of a pulmonary vein is a rare vascular anomaly that is usually discovered incidentally as a pulmonary nodule or mediastinal mass. Most patients do not have any symptoms but some patients can present with dyspnea, hemoptysis, or cerebral thromboembolism. Proper diagnosis is crucial as to avoid unnecessary testing or surgical procedures. We highlight a case of an asymptomatic 59-year-old female with a pulmonary vein aneurysm presenting as a 1.5 cm right infrahilar nodule on contrast-enhanced CT during evaluation for acute cholecystitis. Further investigation with MRA revealed that it was vascular in nature, and pulmonary angiography showed dilation of the right inferior pulmonary vein with no communication to the pulmonary artery. On serial imaging, there has been no change in the size of the aneurysm. A small non-enlarging pulmonary vein aneurysm should be managed expectantly.

Pulmonary venous aneurysm: Forming a glove balloon-like shape

INTRODUCTION

Pulmonary venous aneurysm (PVA) is a candidate for surgery because of the risk of rupture and continued growth even if the patient does not develop mitral valve disorders.

PRESENTATION OF CASE

We report the case of PVA that continued to increase in size throughout a 17-year observational period.

DISCUSSION AND CONCLUSION

The location and form of the aneurysm are important to consider when choosing the surgical approach. If the aneurysm forms a "glove balloon-like shape," lobectomy is necessary because end-to-end anastomosis is difficult to perform in such cases.