Pulmonary Artery Aneurysm Caused by Aspergillus Pneumonia Presenting as an Endobronchial Mass Lesion

Abstract

We present a case of pulmonary artery aneurysm (PA aneurysm) following Aspergillus fumigatus pneumonia treated by coil embolisation. Although rare, PA aneurysms have a high mortality rate with a large proportion of the cases reported being found at post-mortem examination. Aspergillus infection is known to result in aneurysms in immunocompromised patients and in patients with infective endocarditis. The case we report is unusual in that the patient was not obviously immunocompromised, and initially presented with a different pathology. Treatment by endovascular coil embolisation was successfully employed in this instance, allowing the patient to be weaned from ventilatory support. Although this is an unusual complication of Aspergillus pneumonia, the identification and successful treatment of pulmonary artery aneurysms requires a high-index of suspicion.

Endovascular management of a mycotic pseudoaneurysm

“…It is important to indicate that, in addition to pseudoaneurysms caused by other microorganisms, there have also been case reports of this condition associated with COVID-19 infection. 2,[8][9][10][11] In the patient we are discussing, the pseudoaneurysm was thought to have been acquired secondary to an infection. It has been reported that more virulent microorganisms, like the staphylococcal family, can damage all three vessel layers and cause a true aneurysm, while those that are less virulent cause pseudoaneurysms, which would be the case in our patient, who had pulmonary aspergillosis.…”

Manejo endovascular de un pseudoaneurisma micótico

“…También existen reportes de casos en adultos en los que se documentaron pseudoaneurismas por Aspergillus spp., 3 de los cuales presentaban datos de inmunosupresión, y 2 de ellos tenían como antecedente una leucemia, tal como ocurrió con el paciente del caso. Es importante denotar que, además de los pseudoaneurismas generados por otros microorganismos, también se ha descrito, mediante reporte de caso, la presentación de esta entidad asociada a infección por COVID-19 2,[8][9][10][11] .…”

Pulmonary artery mycotic aneurism owing to aspergillus in SARS-CoV-2 convalescent: a case report and literature review

“…9,25,27 The use of antibiotics has been associated with a decrease in the incidence of these, although medical treatment with antibiotics is usually insufficient and carries a risk of persistent infection. 2,25 Open surgical management is the most frequently performed because it avoids the implantation of synthetic material in the focus, however, in some cases it is not feasible due to the morbidity and mortality rate of up to 40% mainly due to comorbidities and it is in these cases that endovascular therapy emerges with favorable results in selected patients, being an effective and minimally invasive procedure, it may even be considered as the first line of treatment by some authors. 9,24,26,28,29 Traditionally, the management of mycotic or infectious aneurysms has consisted of surgical repair with resection of the affected segment, extensive local debridement and repair in situ or with extra-anatomical bridges, these treatment modalities present mortality between 22 and 36%.…”

“…1 Invasive aspergillosis is a serious disease described in immunosuppressed patients and critically ill nonimmunosuppressed patients where autopsy studies suggest that the incidence may be underestimated, COPD, hematological malignancies, bacterial infection, malnutrition, diabetes, renal replacement therapy, frequent use of inhalers and systemic steroids have been considered as risk factors for aspergillosis with a recorded mortality of more than 80%. [2][3][4][5][6] Distinguishing between benign colonization of the respiratory tract and disease represents a diagnostic challenge because it infrequently causes inflammation or invasion, remaining subclinical in most cases. 7 On the other hand, viral pneumonia increases the susceptibility of patients to invasive bacterial and fungal infections since respiratory viruses cause direct damage to respiratory tissue, in addition to hindering ciliary and conidia clearance, which leads to local immune dysfunction manifested as a state of pulmonary immunosuppression.…”