Traumatic injury of the pulmonary artery: Transection, rupture, pseudoaneurysm, or dissection? Sometimes semantics do matter

Abstract

When noninterventional therapy is attempted for traumatic proximal injuries of the pulmonary artery, it is important to determine accurately the exact type, location, and size of the injury.

Traumatic pulmonary artery injury: a review of the recent literature

“…A transection, rupture, disruption, perforation, tear or laceration of the PA is thought to be a near-complete tear through all layers of the PA due to trauma; however, there is no consistent definitive terminology [1] . Clinical symptoms due to such trauma include cardiac arrest or hemodynamic insufficiency due to massive hemorrhaging or cardiac tamponade, and dyspnea due to hemothorax or hemoptysis [1,2] .…”

“…Clinical symptoms due to such trauma include cardiac arrest or hemodynamic insufficiency due to massive hemorrhaging or cardiac tamponade, and dyspnea due to hemothorax or hemoptysis [1,2] . Chest pain due to concomitant thoracic cage injury has also been reported.…”

“…This may form when re-epithelialization of the perforation does not occur, and a delayed diagnosis can occur even 60 years later [5] . The pseudoaneurysm may stabilize and spontaneously resolve or expand and rupture, depending on the etiology, size and intravascular pressure [1] . A pseudoaneurysm can be asymptomatic or characterized by symptoms of hemoptysis, shortness of breath and chest pain [6,7] .…”

“…Five major etiological groups can be identified: congenital malformation, infection or inflammation, acquired cardiac diseases, iatrogenic causes and trauma [15][16][17] . Traumatic PADs usually resolve or remain stable unless associated with pulmonary hypertension, in which case the risk of bleeding can be quite high [1,16] .…”

“…Most vital emergencies involve proximal PAI. However, if PAI can be managed appropriately and promptly in patients without cardiac arrest, the patient may be saved, as PAI can be easily controlled with appropriate procedures due to the low pressure in the PA circulation, provided the injury site is small [1] . In this review article, traumatic PA is anatomically classified into four categories and clinically classified into two major categories: iatrogenic and non-iatrogenic, depending on the mechanism of the trauma.…”