Ruptured pulmonary artery aneurysm: a surgical emergency

Abstract

Idiopathic pulmonary artery aneurysm rupture was diagnosed in a 79-year-old man who presented with a dry cough. He was considered unlikely to tolerate extensive pulmonary artery reconstruction or lung resection; hence, he was salvaged by timely ligation of the distal pulmonary artery at the origin of the aneurysm.

Aneurysms of the Pulmonary Artery

“…34,35 In case of rupture, lethal hemostasis, asphyxiation, exsanguination, and sudden death have been described. 40 Among all reported cases, one third of the patients died as a result of rupture, which underlines the fact that not all PAAs progress to the rupture state. 9,21 Depending on the underlying condition responsible for PAA formation, patients frequently present with right atrial and ventricular hypertrophy, right heart failure, tricuspid regurgitation caused by annulus dilatation, and mild pericardial and pleural effusion.…”

“…9,20,34,36,40,41 A bronchoscopy may show compression of the bronchus. 35 Angiography allows delineation of the PAA within the pulmonary vasculature, involvement of the vascular structure, and assessment of the right-side hemodynamic pressure.…”

“…9,35 In general, contrast-enhanced computed tomography (Figure 3) confirms the diagnosis and provides useful information on size, number, location, and extent of the PAA. 20,[34][35][36]40,41 Furthermore, magnetic resonance imaging (Figure 4) or 4-dimensional magnetic resonance imaging may show arterial wall thickening, provide information on blood flow, and characterize aortic and pulmonary hemodynamics without any radiation exposure. 43 …”

“…Therefore, conservative treatment seems reasonable for asymptomatic patients with PAA with no significant PAH and apparent stability in PAA diameter. 9,14,40 Shunt flow or valvular pathologies cause persistent hemodynamic stress, which may be responsible for PAA formation and dilatation and should therefore be a contraindication for conservative treatment. 14 Overall, idiopathic PAA seem to be a relatively benign condition, and conservative observation may be reasonable when there is normal PA pressure, in contrast to patients with aneurysms of the aorta.…”

Left Hilar Mass Image Forming of Idiopathic Pulmonary Artery Aneurysm

“…Ancak cerrahinin uzun dönem sonuçları bilinmemekte, sonuçları değişken ve cerrahi riskleri çok iyi tanımlanmamıştır (5). Pulmoner hipertansiyonun olmadığı PAA'lı hastalılarda uzun dö-nemde anevrizmanın yırtılma durumunun çok düşük olduğu kabul edilmektedir (5,10). Normal basınçlı PAA'lı hastaların düzenli uzun süre takipleri ile birlikte anevrizmanın progresyonu daha iyi bilinebilecektir.…”