An adult man presenting with hemoptysis caused by mature teratoma with rupture into the bronchus and pericardium and complicated by Haemophilus influenzae infection

Abstract

This case is reported to highlight the possibility of erosion and pseudoaneurysm formation after implantation of the FloWatch-PAB adjustable PA banding system. As far as we are aware, this is the second such complication with this device. 2 The previous reported case had a similar complication, with pseudoaneurysm formation 7 weeks after the insertion. Doubts have been raised about the technical aspect of insertion being the cause for the pseudoaneurysm formation. 1 In our case no intraoperative difficulty was reported. We therefore would like to highlight this specific occurrence of a pseudoaneurysm of the PA as a possible complication of the device rather than a problem with the technique of insertion. We would recommend anyone having this device inserted to have regular and frequent follow-up until the device is removed. References

The peri‐PCI enzyme rise: Speed bump or springboard to disaster?

“…Hemoptysis is an unusual presenting symptom in an otherwise healthy child with a well capsulated, unruptured mature mediastinal teratoma 1–5. In this report, hemoptysis prompted us to undertake the diagnostic work‐up that eventually disclosed the tumor.…”

“…Bleeding could have arisen from an undetected lesion in the upper respiratory tract, or from the bronchial inflammation caused by the consolidation in the left upper lobe. Another possible cause of bleeding was tumor rupture into the bronchus1–5 although this cause was excluded by chest MRI showing a well‐encapsulated tumor as confirmed by the surgeon and by the absence of tumor cells in BAL fluid.…”

A symptomatic anterior mediastinal mass with a simultaneous Haemophilus influenzae infection

“…While symptoms such as haemoptysis and chest pain are more common in ruptured tumours , in this case, the CT obtained at the patient’s initial presentation did not show any rupture of the cystic lesion, and this was coupled with pus‐like material and positive bacterial growth from the aspirated fluid. Infected teratomas in adults are rare, and while a case of H. influenzae and Mycoplasma pneumoniae infection were each reported in ruptured teratomas, the infection of un‐ruptured teratomas was not reported previously.…”

Mediastinum Teratoma Rupture: A Rare Manifestation

“…They are usually asymptomatic and their rupture is a rare event. The adjacent organ involved can be the lung and bronchial tree (which was the case in the patient reported here), pleura [3] , pericardium [4] and great vessels. Different mechanisms have been proposed for spontaneous teratoma rupture including autolysis (tumour glandular enzyme digestion), chemical inflammation, ischaemia, infection and pressure necrosis [5] .…”