Pulmonary Artery Pseudoaneurysm due to Mucormycosis: Case Report and Literature Review

Abstract

Pulmonary artery pseudoaneurysm (PAP) is a rare vascular phenomenon with a high mortality rate, as these entities can enlarge, rupture, and lead to asphyxiation. Pulmonary mucormycosis (PM), an underdiagnosed but an increasingly seen entity in the era of chemotherapy and immunosuppression, is a known cause of PAP, and should be suspected in immunosuppressed patients with hemoptysis. We present a case of PAP due to PM in a patient with recently diagnosed diffuse large B-cell lymphoma of the liver who underwent chemotherapy and developed acute cavitary lung disease and hemoptysis. His diagnosis was delayed due to the withholding of iodinated contrast with computer tomography (CT) imaging in the setting of renal failure. He then underwent embolization of his PAP with resolution of his hemoptysis. PAP is an uncommon cause of hemoptysis that can be diagnosed with CT pulmonary angiography, and mucormycosis is a known but rare cause of PAP in patients with malignancy receiving immunosuppression.

Pulmonary pseudoaneurysm in the setting of concurrent COVID‐19 and pulmonary mucormycosis: A rare case report

“…This approach offers the advantage of preserving blood flow beyond the PAP while carrying a lower risk of complications compared to surgery 21 . However, in cases where there is a rupture of the PAP sac, such as the one described here, early surgical intervention is necessary to ensure patient survival 10 . In addition to that, endovascular equipments are not available in our hospital due to lack of the necessary resources and financial means.…”

“…The occurrence rate of PM varies from 0.005 to 1.7 per million population 9 . Although PM is rare, it should not be underestimated, particularly in immunosuppressed patients, as it can also serve as a causative factor for the development of PAP 10 . PM is known to invade blood vessels through its hyphae, leading to complications such as hemorrhage, thrombosis, infarction, and tissue necrosis 11 .…”

“…Hence, it is crucial to maintain a high level of suspicion and carefully consider the patient's clinical history to ensure a favorable outcome. Additionally, CTPA aids in identifying suitable candidates for potential endovascular interventions 10 . Microorganism demonstration in tissue is the gold standard for confirming a clinical diagnosis of PM.…”

“…In addition to that, endovascular equipments are not available in our hospital due to lack of the necessary resources and financial means. Surgical interventions may involve procedures like pneumonectomy, aneurysmectomy, pulmonary artery arteriorrhaphy, and lobectomy 10 . Subsequent pathological investigations confirmed the presence of a localized mucormycosis infection.…”

“…However, this can be challenging and is often not feasible before surgery. 10 Focal consolidations observed on imaging can be differentially diagnosed as pulmonary thromboembolism, superimposed pneumonia, post-COVID fibrosis, or arterial pseudoaneurysm. 21,22 The preferred method for managing PAPs is endovascular treatment, which includes coil embolization or stent placement.…”