Bronchial artery aneurysm mimicking aortic arch aneurysm or aortic dissection

Abstract

Video clip is available online. Bronchial artery aneurysms (BAAs) are rare. They may be asymptomatic and detected incidentally; however, they can cause airway bleeding, mediastinal bleeding, and sometimes death if they rupture. Here, we present a case of a BAA that was detected secondary to chest pain. It was difficult to diagnose, but bronchial artery embolization (BAE) revealed good results. CLINICAL SUMMARYAn 82-year-old woman presented with chest pain. An enhanced computed tomography (CT) scan that was conducted at a previous hospital suspected an impending rupture of an aortic arch aneurysm. She was therefore FIGURE 1. A, Enhanced computed tomography scan showing a soft tissue-shadow on the caudal side of the aortic arch, and a nodular contrast region inside (arrow). B, In a sagittal plane, the contrast region seemed to be continuous with the aortic arch, but it was unclear if the contrast region was inside the adventitia of the aorta (arrow).

Commentary: Magnetic resonance imaging for diagnosing vascular pathology

“…Presentations similar to aortic dissection have been described. 2 As Ishida and colleagues 3 highlight in this issue of the Journal , BAAs can be difficult to diagnose. In particular, juxta-aortic BAAs may be mistaken for aortic pathology.…”

“…In their case report, Ishida colleagues 3 describe the workup of a mediastinal BAA in a patient presenting with transient chest pain. This BAA was difficult to distinguish from an aortic arch aneurysm versus intramural blood pool associated with aortic dissection on multiple computed tomography (CT) scans.…”

“…The diagnostic dilemma raised by Ishida colleagues 3 highlights the utility of and our increasing reliance on imaging modalities for the diagnosis of vascular pathology. Although contrast-enhanced CT or CT angiography is often an appropriate initial study for diagnosing a BAA and excluding acute aortic syndromes, 4 MRI provides enhanced tissue characterization.…”

Commentary: Bronchial artery aneurysms: Embolization or bust?

“…Detailed radiographic investigations are required, because they will often dictate the proper intervention required for definitive therapy. Ishida and colleagues 1 have reported the unusual presentation of a bronchial artery aneurysm (BAA) presenting with chest pain. Their report highlights the need for sound clinical judgment and the importance of detailed radiographic imaging to arrive at an expeditious diagnosis.…”

“…Given the close proximity of the bronchial artery to the aortic arch, computed tomography imaging alone was not able to definitively rule out aortic pathology. Because the clinical presentation of the patient did not correlate with the usual diagnoses, Ishida and colleagues 1 used magnetic resonance imaging to help identify an intact aortic adventitial plane abutting the BAA.…”