Pulmonary Artery Pseudoaneurysm: Etiology, Presentation, Diagnosis, and Treatment

Lafita, Vaishali; Borge, Marc A.; Demos, Terrence C

doi:10.1055/s-2007-971202

Cited by 50 publications

(59 citation statements)

References 7 publications

(11 reference statements)

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“…The emergency therapeutic options for massive hemoptysis due to pulmonary artery pseudoaneurysms include open surgical techniques (lobectomy and segmentectomy) and percutaneous techniques [1,2]. The pseudoaneurysm may be embolized with coils or microcoils [3], or it can be occluded with a stent graft [7].…”

Section: Discussionmentioning

confidence: 99%

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Massive Hemoptysis from a Pulmonary Artery Pseudoaneurysm during Cardiac Surgery

Cerillo

Barberi

Amoretti³

et al. 2018

Turk Thorac J

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Massive hemoptysis is a life-threatening condition usually related to a pathology of the bronchial arteries. Pulmonary artery pseudoaneurysms represent a relatively rare cause of severe airway bleeding, but are associated with a mortality rate of over 50%. A case of massive intraoperative hemoptysis treated with temporary occlusion of the right pulmonary artery and delayed endovascular occlusion of the feeding segmental artery is described. KEYWORDS:Hemoptysis, pseudoaneurysm, pulmonary artery catheterization, computed tomography INTRODUCTIONMassive hemoptysis is a life-threatening condition usually related to a pathology of the bronchial arteries [1]. Pulmonary artery pseudoaneurysms represent a relatively rare cause of severe airway bleeding, but are associated with a mortality rate of over 50% [2]. We report a case of massive intraoperative hemoptysis treated by temporary occlusion of the right pulmonary artery and delayed endovascular occlusion of the feeding segmental artery. CASE PRESENTATIONWe describe the case of an 80-year-old woman who presented with massive hemoptysis during an open heart procedure. The patient survived and gave her consent for the publication of the present case report.The patient underwent mitral repair at our institution. One hour after the procedure, she had asystolia and was reanimated. Echocardiography performed during cardiopulmonary resuscitation (CPR) showed severe biventricular dysfunction and demonstrated the presence of a right atrial thrombus. The patient underwent emergency surgical re-exploration. Cardiopulmonary bypass (CPB) with bi-caval cannulation was instituted, and the right atrium was explored without cross-clamping the aorta. A 2 × 1 × 0.5 cm thrombus was found in the superior vena cava, adherent to the central venous catheter, and was removed. A 2 cm longitudinal incision was then made on the main pulmonary artery, and the right atrium and ventricle were flushed with a heparin solution. A small sucker was advanced in the left pulmonary artery and retrieved a second small clot. It was then advanced in the right pulmonary artery (RPA), finding no additional thrombotic material. A 6-French Fogarty catheter (Edwards Lifesciences, Irvine, CA) was advanced in the left and RPA branches, but no other thrombi were retrieved. The left and right ventricular function recovered, the right atrium and pulmonary artery were sutured, and the patient was weaned from CPB. However, as soon as the pump flow was reduced, significant hypovolemia developed and massive hemoptysis was observed. Notably, the surface of both lungs appeared normal. CPB was started again and bronchoscopy was performed, but the exploration stopped at the carena due to excessive bleeding. A left-sided Robertshaw endotracheal tube (Covidien Spa, Segrate) was positioned, and the source of bleeding was identified in the right lung. The tracheal lumen was occluded, the patient was weaned from CPB during single lung ventilation, and protamine was administered. However, severe bleeding with hemodynamic instability ...

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Section: Discussionmentioning

confidence: 99%

“…Pulmonary artery pseudoaneurysms represent a relatively rare cause of severe airway bleeding, but are associated with a mortality rate of over 50% [2]. We report a case of massive intraoperative hemoptysis treated by temporary occlusion of the right pulmonary artery and delayed endovascular occlusion of the feeding segmental artery.…”

Section: Introductionmentioning

confidence: 96%

Massive Hemoptysis from a Pulmonary Artery Pseudoaneurysm during Cardiac Surgery

Cerillo

Barberi

Amoretti³

et al. 2018

Turk Thorac J

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“…4 Pulmonary artery pseudo-aneurysms (PAP) may be congenital or acquired. 2,8 Congenital causes: Valvular and post valvular stenosis Left to right shunt, patent ductus arteriosus, VSD, ASD. Patch aneurysms in tetralogy of fallot.…”

Section: Discussionmentioning

confidence: 99%

“…Iatrogenic -due to malpositioned swanz ganz catheter, chest tube insertion, conventional angiography and surgery. 2,8 Chest radiograph may show non-specific findings like focal lung consolidation, solitary pulmonary nodule or a mass. 8 Contrast computed tomography shows a radioenhancing lesion, and can be recommended as a preliminary investigation to demonstrate the Rasmussen's aneurysm.…”

Section: Acquired Causesmentioning

confidence: 99%

“…2,8 Chest radiograph may show non-specific findings like focal lung consolidation, solitary pulmonary nodule or a mass. 8 Contrast computed tomography shows a radioenhancing lesion, and can be recommended as a preliminary investigation to demonstrate the Rasmussen's aneurysm. 6 Although conventional pulmonary angiography is a gold standard for diagnosis, MDCT angiography can confirm the diagnosis.…”

Section: Acquired Causesmentioning

confidence: 99%

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Rasmussen’s Anuerysm Mimicking as a Fungal Ball

M¹,

Krishnaprasad²,

Kudri³

et al. 2014

jemds

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Hemoptysis is a common post pulmonary tuberculosis complication. It is usually due to bronchial artery involvement. Hemoptysis due to pulmonary artery pseudoaneurysm in a tuberculosis cavity is very rare. Such pseudoaneurysm is called Rasmussen's aneurysms which are commonly seen in upper lobes. We are able to demonstrate a big left lower lobe Rasmussen's aneurysm in a 55 years old diabetic male by CT pulmonary angiogram and it was treated successfully by a wedge resection of involved pulmonary segments.

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Three‐dimensional printing in a patient with pulmonary artery pseudoaneurysm and complex congenital heart disease—A case report

Zhu

Zhang

et al. 2020

Clinical Case Reports

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Pulmonary Artery Pseudoaneurysm: Etiology, Presentation, Diagnosis, and Treatment

Cited by 50 publications

References 7 publications

Massive Hemoptysis from a Pulmonary Artery Pseudoaneurysm during Cardiac Surgery

Massive Hemoptysis from a Pulmonary Artery Pseudoaneurysm during Cardiac Surgery

Rasmussen’s Anuerysm Mimicking as a Fungal Ball

Three‐dimensional printing in a patient with pulmonary artery pseudoaneurysm and complex congenital heart disease—A case report

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