Pulmonary Mycotic Pseudo-Aneurysm with a Prior History of Ventricular Septal Defect. Case Report with Review of Literature

Abstract

In general aneurysms of the pulmonary arteries are less frequent than intracranial, aortic or other vascular locations. Infectious causes include bacteria such as Staphylococcus sp and Streptococcus sp, mycobacteria, Treponema pallidium (syphilis) and rarely fungi. We report a 7 year old female with two right-sided parahilar pseudo-aneurysm of fungal origin with a prior history of ventricular septal defect. Pulmonary mycotic pseudo-aneurysms are very rare and require a high suspicion to diagnose. If a patient is still symptomatic for fever and cough for a long time, and consolidation on x-ray is not improving on antibiotics, contrast-enhanced computed tomography is indicated. It can be suspected that the "friable mass attached to ventricular septal defect patch" was a source of fungeal emboli to pulmonary arteries thus giving weight to the infective endocarditis etiology. A prior history of ventricular septal defect repair could favour fungal endocarditis.

Pulmonary artery aneurysm: a review

“…Bacterial infections, such as infective endocarditis, bacterial pneumonia, lung abscess, and staphylococcus bacteremia resulted in another 12 cases. Fungal infections like candida, 69 mucormycosis, 70 aspergillus, and parasitic infections like schistosomiasis 71 were responsible for other cases. Intravenous drug abuse also led to PAA formation with some cases related to staphylococcus bacteremia.…”

Infectious Pulmonary Artery Pseudoaneurysm That Resolved with Conservative Treatment

“…Conservative treatment is mainly applied to non-urgent, asymptomatic cases and may be inadequate in preventing growth or rupture in complex cases (1). In addition, smaller pseudoaneurysms tend to heal by fibrosis on their own (12), and conservative management has been reported to be successful in such cases (3,4,(13)(14)(15)(16)(17)(18)(19)(20). Systemic hemostatic agents may also be effective in decreasing the severity of hemoptysis and possibly reducing the in-hospital mortality of patients with hemoptysis (21,22).…”