Unusual and voluminous pulmonary trunk aneurysm

Abstract

A 65-year-old woman, with hypertension and dyslipidemia, was admitted to our department because of effort dyspnea. The electrocardiogram and physical examination were normal. Transthoracic two-dimensional echocardiography (2DE) showed left and right cardiac chambers with normal dimensions and function (LVEF 65%), mild concentric left ventricle hypertrophy, mild valvular pulmonic stenosis (the continuous-wave Doppler showed a peak velocity of 2.93 m/s, which is consistent with a systolic gradient of 34 mmHg) and aneurysmal dilatation of the main pulmonary artery with extension to the bilateral main branches (Fig. 1). An exercise ECG test showed an inappropriate increase in heart rate and blood pressure at low exercise workloads without ST segment abnormalities. The exercise level was inadequate to test cardiac reserve. A computed tomography (CT) coronary angiography was performed. It showed a voluminous aneurysm (77.6 mm) of the pulmonary artery (Fig. 2), without other cardiac abnormalities. DiscussionPulmonary artery aneurysm (PAAs)-defined as PA dilation greater than 4 cm-is a rare condition, regardless of the cause. The etiology of PAAs can be congenital or acquired. Congenital aneurysms are usually associated with congenital heart diseases causing pulmonary hypertension, and persistent ductus arteriosus is the most frequent. Other congenital causes include atrial and ventricular defects.Acquired causes can be idiopathic or associated with other processes, such as infections (tuberculosis, syphilis), traumatisms, pulmonary valvular stenosis, or diseases affecting collagenous tissue [1,2].In rare cases, when the PAA is not due to a functional or structural anomaly of the cardiovascular system, it is known as an idiopathic PAA.Clinical presentation of a PAA varies. It can be asymptomatic, being a chance finding in a chest X-ray study, echocardiography or computed tomography. In symptomatic patients, dyspnea, hemoptysis and chest pain are the most frequent complaints [1,3].