Giant mediastinal bronchial artery aneurysm mimicking benign esophageal tumor: a case report and review of 26 cases from literature

Abstract

Mediastinal bronchial artery aneurysm is rare but potentially life-threatening, and requires prompt treatment to avert rupture with catastrophic results. A 78-year-old man was referred to our hospital with a benign esophageal tumor, which appeared as an extrinsic, extramucosal filling defect on an esophagogram. Chest computed tomography and selective bronchial arteriography led to a definitive diagnosis of mediastinal bronchial artery aneurysm. Aneurysmectomy and closure of the ostia of both the afferent and efferent bronchial arteries was performed via standard posterolateral thoracotomy. Postoperative course was uneventful, and the patient was discharged on the seventh postoperative day.

Aortic Stent-Graft for a Giant Bronchial Artery Aneurysm with Ultrashort Neck

“…In addition, complete embolization of the afferent artery is difficult when the vascular segment between the bronchial artery aneurysm and the aorta is short. 2,4) In our patient, a conventional surgical approach to the aneurysm was potentially problematic because of her age and reduced pulmonary function. Initially, we attempted transcatheter BAE using PVA particles, gelfoam particles, and microcoils.…”

“…It has been proposed that bronchial artery aneurysms are caused by focal weakening or injury of the vessel wall, although increased bronchial arterial flow might also play a role. 1,2) Two approaches are used to treat bronchial artery aneurysms, namely, surgical resection or ligation of the lesion and BAE. The surgical approach reliably eliminates the lesion, but may be unsuitable in patients at high risk that cannot tolerate thoracotomy.…”

“…The surgical approach reliably eliminates the lesion, but may be unsuitable in patients at high risk that cannot tolerate thoracotomy. 2) Transcatheter BAE is being increasingly applied to treat bronchial artery aneurysms because it is less invasive and offers successful aneurysm exclusion with shorter hospital stays. 3) However, collateral vessels, incomplete embolization, and arterial re-canalization may cause revascularization of the aneurysm.…”

Hemothorax Complicating Bronchial Artery Aneurysm

“…This suggests that the etiology may be chronic inflammation surrounding, or directly involving, the artery (2). Asymptomatic lesions may present as esophageal masses, with or without compression, thus prompting workup for malignancy or leiomyoma (3,4). They can also mimic the radiographical appearance of aortic aneurysms (5).…”

“…They can also mimic the radiographical appearance of aortic aneurysms (5). Size does not predict the risk of complications because lesions as large as 8 cm to 10 cm in diameter can present with radiographical findings only, while those as small as 2 cm have presented with lifethreatening bleeding (3,6,7). The most common hemorrhagic presentation is hemoptysis, followed by hematemesis, depending on whether the aneurysm extends parenchymally or posteriorly (5,8,9).…”