A Late Presentation of Giant Traumatic Pulmonary  Artery Aneurysm

Surov, Alexey; Spielmann, Rolf-Peter; Werdan, Karl; Buerke, Michael; Behrmann, Curd

doi:10.1161/circulationaha.110.974758

Cited by 3 publications

(1 citation statement)

References 2 publications

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“…A pseudoaneurysm is an encapsulated hematoma in communication with the lumen of a ruptured vessel. This may form when re-epithelialization of the perforation does not occur, and a delayed diagnosis can occur even 60 years later [5] . The pseudoaneurysm may stabilize and spontaneously resolve or expand and rupture, depending on the etiology, size and intravascular pressure [1] .…”

Section: Anatomical Classificationmentioning

confidence: 99%

Traumatic pulmonary artery injury: a review of the recent literature

Yanagawa¹,

Ishikawa²,

Nagasawa³

et al. 2018

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Pulmonary artery injury (PAI) is rare, lethal clinical entity. Traumatic PAI is anatomically classified into transection/ rupture/laceration, pseudoaneurysm, dissection and fistula. In addition, traumatic PAI is clinically classified into two major categories: iatrogenic and non-iatrogenic, depending on the mechanism of the trauma. The frequency, clinical symptoms and treatment differ between the two clinical categories. If PAI can be managed appropriately and promptly in patients without cardiac arrest, the patient may be saved, as PAI can be easily controlled with appropriate procedures due to the low pressure in the PA circulation.

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Section: Anatomical Classificationmentioning

confidence: 99%

Traumatic pulmonary artery injury: a review of the recent literature

Yanagawa¹,

Ishikawa²,

Nagasawa³

et al. 2018

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Aneurysms and Pseudoaneurysms of the Pulmonary Vasculature

Restrepo

Carswell

2012

Seminars in Ultrasound, CT and MRI

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Left Pulmonary Artery Transection After Penetrating Thoracic Trauma

Blanié

Fadel

Duranteau

2011

Journal of Trauma: Injury, Infection &Amp; Critical Care

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W e report the case of a stable hemodynamic patient with pulmonary artery transection after penetrating chest trauma. A 39-year-old man was referred to our institution after a penetrating chest injury with a circular saw. His hemodynamic and respiratory status were stable. A left thoracic wound was noted. Hemoglobinemia was 15.3 g/dL. The thoracic computed tomography (CT) scan showed a metal foreign body of 32 mm by 13 mm causing transection of left pulmonary artery with pseudoaneurysm formation (Fig. 1, A to C). There was also a sternal fracture but no pneumothorax or hemothorax. Considering hemodynamic stability, a direct medical transfer to the operating room of our affiliated cardiothoracic center was organized. A bronchial fibroscopy eliminated an associated bronchial lesion. Operation began by median sternotomy incision, and circulatory bypass without aortic clamp was instituted to discharge the right heart. The pleural cavity was then opened and the pulmonary artery dissected. A lesion of the left pulmonary artery with 2 cm 2 parietal defect was observed and treated by pericardial patch (Fig. 1, D). A metal foreign body of 3.5 cm was also extracted and a segmentary artery of the left pulmonary artery was ligatured. No blood transfusion or vasoactive drug was necessary. A control thoracic CT scan showed good perfusion of the pulmonary artery, but a minor left pulmonary embolism treated by anticoagulant. The patient was discharged home on postoperative day 13.Traumatic transaction of the pulmonary artery with pseudoaneurysm formation is rare and often lethal. Most patients die in prehospital or emergency room phase. Others present with hemodynamic instability secondary to massive hemothorax, hemomediastinum, or acute pericardial tamponade. Some exceptional patients presented hemodynamic stability. This can be explained by the low pressure in the pulmonary artery and the local hemostasis provided by the limited extensibility of the mediastinum. Some delayed cases of pseudoaneurysm have been diagnosed 60 years after chest trauma, fortuitously or in thoracic pain, or hemoptysis context. 1,2 Usually, after chest trauma, the diagnosis was made by CT scan, sometimes completed by pulmonary angiogram. A bronchial fibroscopy is also necessary to eliminate an associated bronchial lesion. In the acute phase, the risk of rupture with fatal hemorrhage, secondary sepsis, and fistulization is important and immediate surgical treatment is necessary. 3,4 In this case, the left pulmonary arterial tear was located in the mediastinal portion of that vessel close to the pulmonary trunk, preventing safe proximal vascular control through left thoracotomy. A median sternotomy was then performed, followed by vascular control under cardiopulmonary bypass, to avoid acute hemorrhage. Simple arterial lacerations may be repaired without pulmonary bypass, but it is required when more extensive injury of the pulmonary artery is suspected. In case of pseudoaneurysm without penetrating trauma, therapeutic abstention or angiographic embolizat...

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A Late Presentation of Giant Traumatic Pulmonary Artery Aneurysm

Cited by 3 publications

References 2 publications

Traumatic pulmonary artery injury: a review of the recent literature

Traumatic pulmonary artery injury: a review of the recent literature

Aneurysms and Pseudoaneurysms of the Pulmonary Vasculature

Left Pulmonary Artery Transection After Penetrating Thoracic Trauma

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