A Rare Case of Ruptured Bronchial Artery Pseudoaneurysm and Its Nonsurgical Management With Interventional Techniques

Abstract

Ruptured bronchial artery pseudoaneurysms with mediastinal hematoma are rare entities with a very limited number of published cases to date. The diagnosis of such cases can be difficult as the patient may present with symptoms mimicking other diseases, mainly mediastinal malignancy. A high degree of clinical suspicion and imaging techniques like contrast-enhanced computed tomography (CECT) chest and computed tomography angiography (CTA) aids in the diagnosis. Under the lights of an interventional radiologist, an urgent endovascular approach is most commonly preferred for its nonsurgical management. We present a rare case of a 47-yearold male with no previous lung disease or trauma with dyspnea and sudden onset chest pain. A massive effusion was suspected on the right side. CECT chest and digital subtraction angiography (DSA) revealed a pseudoaneurysm of a bronchial vessel with associated mediastinal hematoma, collapse of basal right lower lobe, and collection in right pleural space. This patient was later successfully treated by endovascular embolization techniques. Bronchial artery pseudoaneurysm may be considered a remote possibility in the absence of trauma or other lung diseases that may present with a massive hemothorax or mediastinal hematoma. Although CECT can be useful, digital angiography is considered the gold standard. Early intervention with the endovascular approach is a commonly recommended technique.

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

“…The main causes represented in our recent literature review were infective (36.7%), paraneoplastic (31.8%), Swan-Ganz-induced (13.6%), traumatic (9%), post-surgical (4.5%), and iatrogenic (4.5%) [7][8][9][10][11][12][13][14][23][24][25][26]31,32,44,[54][55][56][57][58].…”

“…Other causes of PAAs and PAPAs include vasculitis, pulmonary hypertension, lung neoplasms, and iatrogenic factors such as cardiopulmonary surgery, radiotherapy, and percutaneous procedures [15,16]. Post-traumatic PAPAs due to direct or indirect trauma and iatrogenic pseudoaneurysm formation due to Swan-Ganz catheter mispositioning or repetitive traumatic injury of permanent venous or arterial catheters can also occur [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The presentation of PAPAs may be asymptomatic or, often, characterized by massive hemoptysis, dyspnea, and coughing, which can quickly evolve into hypovolemic hemorrhagic shock if not treated promptly [32][33][34][35][36][37][38][39][40][41][42][43].…”

Right proximal sub-clavian artery pseudoaneurysm masquerading as right upperzone opacity of lung

“…Trauma, infections, rupture of an aneurysm, iatrogenic causes, vasculitis, connective tissue disorder, malignancies, or even coagulopathies can all cause a pseudoaneurysm. 5 Aortic arch aneurysms can cause compression of the left recurrent laryngeal nerve, resulting in hoarseness of the voice and other nearby organs/tissues. 6 Ortner's syndrome is the medical term for this condition.…”

Multimodality Image-Guided Embolization of Bronchial Artery Pseudoaneurysm in a Patient With Aortopathy

“…BA pseudoaneurysms are extremely rare clinical entities, with very few cases reported in the literature ( Table 1 ). 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 Although rare, they can be fatal when ruptured.…”