Swan-Ganz catheter-induced pulmonary artery pseudoaneurysm formation: three case reports and a review of the literature

Infectious Pulmonary Artery Pseudoaneurysm Secondary to a Lung Abscess Treated With Pulmonary Artery Coil Embolization: A Case Report

Pulmonary artery pseudoaneurysms (PAPs) are uncommon, yet they frequently result in hemoptysis and are associated with a poor prognosis. We report a case of an 87-year-old male patient. Initially, he was admitted to a previous hospital, and diagnosed with a lung abscess in the left lower lobe. On the second hospital day, he developed hemoptysis. A contrast-enhanced chest computed tomography (CT) identified an infectious pulmonary artery pseudoaneurysm. On the ninth hospital day, pulmonary artery coil embolization was successfully performed, significantly improving the patient's condition.

Pulmonary pseudoaneurysm in the setting of concurrent COVID-19 and pulmonary mucormycosis: A rare case report

Key Clinical Message

This case illustrates the possible danger of PAP emergence in individuals with a confluence of conditions capable of inducing vascular impairment, like COVID-19, pulmonary mucormycosis (PM), and diabetes.

Abstract

Pulmonary mucormycosis (PM) is a highly lethal invasive infection. It is a rare complication of COVID-19 and is associated with a high mortality rate. Pulmonary pseudoaneurysm (PAP) is a severe manifestation of this condition, often resulting in death. Management involves endovascular therapy followed by surgery and appropriate antifungal treatment.

Endovascular treatment for massive haemoptysis due to pulmonary pseudoaneurysm: report of 23 cases

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.

Pulmonary Artery Pseudoaneurysms Embolization: Bicentric Experience and Review of the Literature

The purpose of this bicentric case series was to report the safety, efficacy, and clinical outcome of transcatheter embolization in pulmonary artery pseudoaneurysms (PAPAs). Between January 2016 and June 2021, eight patients with PAPA were subjected to transcatheter embolization. The total number of patients was eight, of which five were female, with a mean age of 62 ± 14 years (average ± standard deviation). Etiology was traumatic in 2/8 cases and iatrogenic in 6/8 cases (after positioning a Swan-Ganz catheter in 5/6 cases and a temporary pacemaker in the latter case). In a single case, the PAPA was incidentally discovered during a routine X-ray, in the remaining 7 cases, the procedure was performed in emergency settings. PAPA embolization was performed using detachable coils alone in 3 cases; coils and glue in 1 case; coils, glue, and vascular plug in 1 case; coils and non-adhesive liquid embolic agents (Onyx and Squid respectively) in 2 cases; and non-adhesive liquid embolic agent alone (Onyx) in 1 case. No peri-procedural or post-procedural complications were recorded. Both the technical and clinical success rates were 100.0%. In conclusion, endovascular embolization is a technically feasible and safe therapeutic option for patients with PAPAs.

Pulmonary artery pseudoaneurysm: an unsuspected cause of haemoptysis in Post-COVID fungal infection of the chest

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.

Pulmonary Arterial Dilatation: Imaging Evaluation Using Multidetector Computed Tomography

Pulmonary artery dilatation comprises a heterogeneous group of disorders. Early diagnosis is important as the presentation may be incidental, chronic, or acute and life threatening depending upon the etiology. Cross-sectional imaging plays an important role, with CT pulmonary angiography being regarded as the first line investigation in the evaluation of pulmonary artery pathologies. Moreover, effects of pulmonary artery lesions on proximal and distal circulation can also be ascertained with the detection of associated conditions. Special attention should also be given to the left main coronary artery and the trachea-bronchial tree as they may be extrinsically compressed by the dilated pulmonary artery. In context of an appropriate clinical background, CT pulmonary angiography also helps in treatment planning, prognostication, and follow-up of these patients. This review mainly deals with imaging evaluation of the pulmonary arterial dilatations on CT with emphasis on the gamut of etiologies in the adult as well as pediatric populations.

Multiple pulmonary artery aneurysms in a young female with patent ductus arteriosus on CT pulomnary angiography

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.

Pulmonary Artery Pseudoaneurysm Associated With Abandoned Epicardial Defibrillator Patch

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.

Esophagopulmonary fistula causing pulmonary arterial pseudoaneurysms and massive hemoptysis

An esophagopulmonary fistula (EPF) may occur in patients with esophageal carcinoma and result in pulmonary abscess formation. Lung abscesses may in turn cause pulmonary artery (PA) pseudoaneurysms and life-threatening hemoptysis. We report a 59-year-old man with past medical history of metastatic distal esophageal adenocarcinoma who presented with fever, cough, and massive hemoptysis. Imaging evaluation demonstrated an EPF, associated lung abscess, and PA pseudoaneurysms. The presented case illustrates that embolization of PA pseudoaneurysms to prevent bleeding, and endoscopic esophageal covered stent graft placement to divert esophageal contents from the abscess, may facilitate a favorable outcome.

Trisegmentectomy for traumatic left superior pulmonary vein pseudoaneurysm

Traumatic pulmonary vein pseudoaneurysms are an extremely rare and dangerous phenomenon. These pseudoaneurysms are caused by both penetrating and blunt thoracic trauma, with late sequelae of pseudoaneurysm rupture and high output cardiac failure secondary to arteriovenous fistula. We present a unique case of pulmonary vein pseudoaneurysm due to penetrating chest trauma managed by segmentectomy using thoracic principles of lung preservation.

Pulmonary artery aneurysms: diagnosis & endovascular therapy

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.

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.

Preliminary Experience of Endovascular Embolization Using N-Butyl Cyanoacrylate for Hemoptysis due to Infectious Pulmonary Artery Pseudoaneurysms via Systemic Arterial Approach

We report 5 patients with hemoptysis due to infectious pulmonary artery pseudoaneurysm (PAP) treated with endovascular embolization using N-butyl cyanoacrylate (NBCA) injected via bronchial and nonbronchial systemic arterial approaches. Infectious diseases included inactive tuberculosis (n = 3), nontuberculous mycobacteriosis (n = 1), and chronic infection of unknown origin (n = 1). Seven PAPs were detected on selective systemic angiography, and injection of NBCA was performed. Disappearance of all PAPs was confirmed on systemic arteriography after the intervention. In all patients, hemoptysis was stopped without major complications, and it did not recur during the follow-up period (mean, 351 d; range, 285-427 d).

Pulmonary artery rupture as a complication of Swan-Ganz catheter application. Diagnosis and endovascular treatment: a single centre's experience

Introduction

The placement of a Swan-Ganz catheter into the pulmonary artery may lead to a number of complications (2–17%). In less than 0.2% of cases Swan-Ganz catheterization results in serious vascular damage – pulmonary artery rupture (PAR). This paper presents two distinct forms of iatrogenic PAR treated endovascularly using different vascular devices.

Aim

To evaluate the effectiveness of endovascular treatment and the application of different types of vascular devices in the management of pulmonary artery rupture caused by Swan-Ganz catheterization.

Material and methods

In this retrospective study we evaluated 2 patients in whom Swan-Ganz catheter application was used for perioperative monitoring and resulted in pulmonary artery rupture. This complication was treated endovascularly by means of interventional cardiology.

Results

We report the cases of 2 patients with a pulmonary artery pseudoaneurysm formed in the perioperative period. In case 1, a single, 4-loop, 3 mm diameter coil was implanted. In case 2, a 5 mm Amplatzer Vascular Plug IV was applied. In both cases, the endovascular approach resulted in total occlusion of the feeding artery and reduced further extravasation of the blood.

Conclusions

Despite its extremely low incidence, iatrogenic PAR is a serious, life-threatening complication of Swan-Ganz catheterization that requires urgent attention. Among available methods of treatment, percutaneous embolization is a relatively quick, safe, accurate and highly effective alternative to traumatizing surgery.

Endovascular treatment of a pulmonary artery pseudoaneurysm caused by Swan-Ganz catheter deployment in an anticoagulated patient

We present a case report of an anticoagulated 78-year old man presenting a pulmonary artery pseudoaneurysm following Swan-Ganz catheter deployment after an aortic valve and aortic root replacement. Diagnosis was established by cone beam CT angiography and catheter angiographyand embolisation was achieved via a combination of plug and glue. This case emphasises the importance of endovascular techniques in the management of iatrogenic pulmonary pseudoaneurysms and shows the benefit of using highly hemostatic polymeric agent in anticoagulated patients to obtain a rapid and effective occlusion.

Imaging of vascular pseudoaneurysms in the thorax and abdomen

INTRODUCTION

This review article illustrates a spectrum of arterial pseudoaneurysms that may occur in various locations throughout the thoracoabdominal region. This article discusses the common etiologies and typical clinical presentations of arterial pseudoaneurysms as well as the imaging modalities employed in their diagnosis and potential treatment options.

OBJECTIVE

The goal of this review article is to familiarize radiologists with the diagnosis of thoracoabdominal arterial pseudoaneurysms, the prompt identification and treatment of which are crucial in this patient population.

CONCLUSION

In summary, a thorough understanding of the etiologies, imaging characteristics, and clinical implications of pseudoaneurysms can help optimize identification and management of this spectrum of disease.

Stenting as a rescue treatment of a pulmonary artery false aneurysm caused by swan-ganz catheterization

Pulmonary vascular injury is a rare but life-threatening complication of Swan-Ganz catheterization. We report an 82-year old patient who underwent right heart catheterization by a balloon-tipped catheter because of suspected pulmonary hypertension. After deflation of the catheter in the wedge position, hemoptoe appeared associated with acute respiratory insufficiency requiring respiratory support by intubation and mechanical ventilation. Pulmonary angiography showed the formation of a false aneurysm of a segment artery of the left lower lobe. Immediate interventional therapy was performed by the implantation of two coated coronary stent grafts into the injured pulmonary artery thereby excluding the false aneurysm. Bleeding was stopped by this interventional approach while antegrade blood flow was maintained. Long term follow-up after 3 months showed an effective treatment with a completely thrombotic false aneurysm. However, despite oral anticoagulation and dual antiplatelet therapy, graft patency could not be achieved after 3 months. In summary, implantation of coated stents is a feasible and safe approach for the acute and long term treatment of potentially life-threatening condition of a pulmonary artery false aneurysm while treatment to achieve long term patency of the affected vessel still remains an issue to be resolved.

Imaging of iatrogenic conditions of the thorax

Common medical interventions performed by cardiologists, radiologists, surgeons, dentists, and alternative practitioners can result in complications within the thorax that lead to significant patient morbidity. Prompt radiologic identification of iatrogenic complications of medical procedures in the thorax is essential to guide patient triage and treatment. Understanding the approach to common thoracic interventions and the placement of thoracic medical devices can aid radiologists in the evaluation of iatrogenic complications.

Endovascular treatment of PA pseudoaneurysm caused by Swan-Ganz catheter

The following case report describes a complication of Swan-Ganz catheterization and its endovascular treatment with a single coil. Application of this particular catheter in the pulmonary artery during cardiac surgery may lead to mechanical perforation and creation of an extravascular sac, which is called a pseudoaneurysm. There are different methods that lead to tamponade or closure of the leakage. Interventional cardiology procedures are nowadays the most appropriate way of treatment of Swan-Ganz catheter induced vascular complications.

Pulmonary artery pseudoaneurysm after Swan-Ganz catheterization: a case presentation and review of literature

INTRODUCTION

The Swan-Ganz catheter for pulmonary artery (PA) cannulation was introduced in 1970 and has been utilized in the management of critically ill and cardiac patients. Although the routine use of this catheter has not been associated with better patient outcomes in prospective randomized trials, their ability to provide crucial hemodynamic measurements and the ease of bedside insertion makes them valuable in certain complex clinical scenarios. However, Swan-Ganz catheter insertion is not without complications. PA injury is the most serious complication suspected by the occurrence of hemoptysis after the procedure. We present a case of PA injury with pseudoaneurysm formation after Swan-Ganz catheterization along with a comprehensive review of literature.

METHODS

We reviewed all PubMed/Medline indexed articles published between 1993-2013, reporting the development of PA pseudoaneurysm after Swan-Ganz catheter use. Cases were analyzed with specific reference to patient demographics, indication for Swan-Ganz insertion, initial presenting symptom, duration between insertion and first evidence of PA injury, inciting event, site of pseudoaneurysm, treatment and outcome.

RESULTS

Forty-one patients were identified from 27 papers. In the reviewed population, 87.8% were older than 60 years of age and 82.9% were females. Fifty-one percent of the patients had an episode of hemoptysis on the day of Swan-Ganz catheter insertion. Ninety-seven percent of the patients had PA pseudoaneurysm in the right pulmonary circulation. The admission-to-discharge mortality rate in the reviewed cohort was 15%. Cause of death in 22% of the cases was hemoptysis, while non-catheter related complications were responsible for the remaining deaths.

CONCLUSION

PA injury is a feared complication after Swan-Ganz catheterization and can be fatal. In patients who develop massive or recurrent hemoptysis after Swan-Ganz catheter use, PA injury must be considered and airway protection should be employed along with appropriate catheter based or surgical interventions.

Successful application of subcutaneous adipose tissue with fibrin glue in conservative treatment of tracheobronchial rupture

An 84-year-old woman underwent aortic and mitral valve replacement. After weaning from cardiopulmonary bypass, hemorrhage was observed in the endobronchial tube. The bleeding bronchus was isolated to protect the airway using the blocker cuff of a Univent tube (Fuji Systems Corp, Tokyo, Japan). Computed tomography showed a pulmonary pseudoaneurysm in the left upper lobe. She underwent selective pulmonary angiography and embolization of the pseudoaneurysm. Bronchoscopy revealed a 5-mm bronchial rupture at the left upper lobe bronchus. The laceration was filled with adipose tissue and fibrin glue. Bronchoscopy showed a completely reepithelialized membrane, and she was discharged 38 days postoperatively.

Pulmonary artery pseudoaneurysm: etiology, presentation, diagnosis, and treatment

Pulmonary artery pseudoaneurysms (PAPs) are uncommon but associated with high mortality. Left untreated, lesions can enlarge, rupture, and lead to exsanguination and death. Presentations range from life-threatening hemorrhage to silent lesions that enlarge for days, months, or years. Because abnormalities on imaging studies can lead to early diagnosis and treatment and embolization is the treatment of choice, the radiologist can contribute to both timely diagnosis and treatment of PAPs. Pseudoaneurysms due to penetrating trauma, blunt trauma, bacterial endocarditis, and complications related to pulmonary artery catheters and right heart catheterization are presented. Three were treated by embolization.

Bronchial artery embolization in patients with hemoptysis including follow-up

BACKGROUND; Hemoptysis can be an acute medical emergency, which can be localized angiographically and controlled by therapeutic intervention.

PURPOSE

To evaluate the effectiveness and safety of bronchial artery embolization, and including follow-up in patients with hemoptysis.

MATERIAL AND METHODS

Thirty-five vascular interventions were performed in 28 patients (nine women and 19 men, mean age 42 years, age range 20-82 years) treated for hemoptysis between January 1998 and October 2008. Underlying diseases were cystic fibrosis (n = 9), lung cancer (n = 6), chronic inflammatory disease (n = 4), bronchiectasis (n = 3), chronic obstructive pulmonary disease (n = 2), and other (n = 4). Bronchial artery embolization was performed using particles. Patients were followed up for a median of 23 months (range 1 month to 8 years).

RESULTS

Bronchial artery embolization was technically successful in all patients (bleeding halted within 24 hours). Recurrent bleeding occurred in four patients with cystic fibrosis (14%) at one, 16, 19 and 48 months, respectively. Within this subset, multirecurrence bleeding occurred in one patient with cystic fibrosis. Cumulative patient survival rate was 74% at eight years. No patient died due to hemoptysis but due to underlying disease.

CONCLUSION

Bronchial artery embolization was highly effective in patients with hemoptysis. It may help to avoid surgery in patients who are poor candidates for surgery. Should hemoptysis recur in these patients, repeated embolization can be performed.

Perforation of the right ventricle induced by pulmonary artery catheter at induction of anesthesia for the surgery for liver transplantation: a case report and reviewed of literature

We report a case of a 45-year-old male patient diagnosed with liver cirrhosis by hepatitis C and alcohol, with a Child-Pugh score C and a model for end-stage liver disease (MELD) score of 27, and submitted to liver transplantation. The subject underwent insertion of the pulmonary artery catheter (PAC) in the right internal jugular vein, with technical difficulty concerning catheter advance. There was sudden hypotension, increase in central venous pressure (CVP), and decrease in SvO₂ 15 minutes after the PAC had been inserted, followed by cardiorespiratory arrest in pulseless electrical activity (PEA), which was promptly assisted with resuscitation. Pericardiocentesis was performed without success, so the individual was subjected to a subxiphoid pericardial window, which led to output of large amounts of blood as well as PEA reversal to sinus rhythm. Sternotomy was performed; rupture of the apex of the right ventricle (RV) was detected, and suture of the site was accomplished. After hemodynamic stabilization, the patient was transferred to the ICU, where he developed septic shock and, despite adequate therapy, died on the eighteenth day after ICU admission.

Pulmonary artery catheter induced pulmonary haemorrhage

Since its introduction three decades ago, the pulmonary artery (PA) catheter has brought insights into pathophysiology of many diseases enabling intensivists to treat critical conditions much more precisely and securely. PA indications are widening, and those working in an intensive care environment feel more secure in handling critical conditions with objective data. However, PA-induced pulmonary haemorrhage is a well-recognised, uncommon, yet potentially lethal, complication of PA catheter. We report a case with PA haemorrhage induced by placement of the PA catheter during coronary artery bypass surgery. A contrast-enhanced CT scan of the chest confirmed spontaneous remission of the haemorrhage after 7 weeks of the injury without the need for any intervention.

Pulmonary artery pseudoaneurysm after a vascular access port catheter implantation

Pulmonary artery pseudoaneurysm is an unusual complication of surgically implantable central venous port catheters. We experienced a case of a 57-year-old man with gastric malignancy, in which a port catheter had been previously implanted for chemotherapy. Because of a puncture site that was also medial for the subclavian vein, the catheter tip fractured between the first rib and the clavicle, and embolized in the left pulmonary artery, which caused a 5 x 4 cm pseudoaneurysm that mandated surgical resection with a lobectomy. The diagnostic work-up and a review of the literature are presented.

Pulmonary artery catheters: state of the controversy

Since 1970, pulmonary artery catheters (PACs) have been used in clinical practice to monitor the hemodynamic status of critically ill and injured patients. This technology was introduced and commercialized without considerable testing to determine safety and efficacy. After years of common clinical use, investigators identified potential increases in mortality associated with PAC use. For the past decade, investigators have studied various patient populations to elucidate the safety and efficacy of the PAC. This article reviews the historical context of PAC use, findings from recent clinical trials intended to determine safety and efficacy, issues with reliability and validity of PAC use, and complications associated with PAC use. Data from recent clinical trials do not support routine use of PACs, and the authors suggest that PAC-guided therapy should be the focus of study in future trials.

Hemoptysis secondary to pulmonary artery pseudoaneurysm after necrotizing pneumonia

This case documents the occurrence of hemoptysis secondary to pulmonary artery pseudoaneurysm in a 19-year-old man who was admitted for hypertriglyceridemic pancreatitis. The pseudoaneurysm derived from a necrotizing pneumonia within the same pulmonary segment. After an extensive workup, the pseudoaneurysm was diagnosed by pulmonary angiography and treated with coil embolization.

Embolization of a pulmonary arterial pseudoaneurysm with endovascular coils

Unrecognized pseudoaneurysm or rupture of a pulmonary artery is a rare but potentially catastrophic complication of pulmonary arterial catheterization. Herein, we describe a teenage patient with a pulmonary arterial pseudoaneurysm, probably iatrogenic, who presented with haemoptysis following catheterization of the right heart. The pseudoaneurysm was successfully embolized using coils inserted by catheter. Increased awareness of this lesion, its rapid recognition, and prompt therapy are the keys to a successful outcome.

A pulmonary artery false aneurysm after right middle lobectomy: a case report

Pulmonary artery false aneurysm is a rare condition, reported to complicate interventional procedures. We report a case of a false aneurysm of the interlobar pulmonary artery following a right middle lobectomy for lung cancer. This is probably the first reported case.

The Role of Pulmonary CT Angiography and Selective Pulmonary Angiography in Endovascular Management of Pulmonary Artery Pseudoaneurysms Associated with Infectious Lung Diseases

PURPOSE

To determine the value of performing selective angiography based on the findings of pulmonary computed tomographic (CT) angiography for the detection of a pulmonary artery pseudoaneurysm (PAP) associated with infectious lung diseases and to evaluate the usefulness of endovascular management of these PAPs.

MATERIALS AND METHODS

Over a 6-year period, 11 PAPs were diagnosed in 10 patients (seven men and three women; age, 23-84 years). All patients presented with massive hemoptysis. The underlying diseases were cavitary pulmonary tuberculosis (n = 7), lung abscess (n = 2), and a fungus ball (n = 1). The detection rates of PAP by bronchial/thoracic angiography, main pulmonary angiography, and selective pulmonary angiography were analyzed. When a pseudoaneurysm was detected, feeding artery occlusion was performed with coils or n-butyl cyanoacrylate.

RESULTS

The findings of main pulmonary angiography were contrast agent filling of the pseudoaneurysm (n = 4) and hypoperfusion of the diseased pulmonary segment without contrast agent filling of the pseudoaneurysm (n = 6). The selective angiogram based on pulmonary CT angiography demonstrated five cases of pseudoaneurysm that were not found on the main pulmonary angiogram. Embolization of the pseudoaneurysm was successfully performed in nine of the 10 patients. One patient experienced a rupture of the subsegmental branch of the inferior pulmonary artery during the procedure.

CONCLUSION

Because main pulmonary angiography alone may fail to demonstrate a pseudoaneurysm, a selective angiogram based on the anatomic information obtained from pulmonary CT angiography is essential for detection of a pseudoaneurysm. In addition, endovascular management of a PAP appears to be a safe and effective treatment.