Lung Pathology: Student/Resident Case Report Poster - Lung Pathology II |

Pseudoaneurym: A Rare Cause of Hemoptysis FREE TO VIEW

Bilal Lashari, MD; Zahra Qamar, MD; Faizan Malik, MD; Rajesh Patel, MD
Author and Funding Information

Abington Jefferson Health, Abington, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):809A. doi:10.1016/j.chest.2016.08.905
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SESSION TITLE: Student/Resident Case Report Poster - Lung Pathology II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Pseudoaneurysms of the pulmonary vasculature are uncommon and contribute to significant morbidity and mortality, with varied presentations that evade timely diagnosis. We present a case of pulmonary artery pseudoaneurysm secondary to an upper lobar lobectomy which contributed to a prolonged and complicated hospitalization of what appeared to be pneumonia at presentation.

CASE PRESENTATION: A 79 year old gentleman presented with shortness of breath and fever a week after undergoing a right upper lobectomy and mediastinal lymph node clearance for T1bN1M0 Non-small cell lung cancer. A chest X-ray showed a stable postoperative right pulmonary infiltrate and pleural effusion. Diagnosed as pneumonia, he developed scant hemoptysis on the second day and hemodynamic compromise on the third day of admission culminating in pulseless electrical activity arrest and emergent ACLS guided resuscitation. Upon successful return of circulation maintained with pressor support and mechanical ventilation, imaging in form of a chest CT was sought; which showed the development of a large pseudoaneurysm at the level of the right upper lobe arising from the central right pulmonary artery branch. Emergent thoracotomy and completion pneumonectomy was then performed, as he was not a candidate for endovascular intervention secondary to a grossly consolidated lung and previous lobectomy. He required pressor and ventilator support post operatively, had a prolonged and complicated hospital course owing to multiple complications and subsequent mortality.

DISCUSSION: Pseudoaneurysms are common in the systemic circulation and cause primarily by a disruption of the structural layers of the arterial wall. Pulmonary vasculature may be involved in a plethora of conditions with documented associations in cases of autoimmune disease, neoplasia, fungal infections such as aspergillosis and blunt or penetrating trauma. Unusually, these may be caused by invasive therapeutic interventions such as Swan Ganz catheterization, and Radiotherapy. There is literature reporting development secondary to lobectomy and partial pneumonectomy however, mechanisms causing the development of pseudoaneurysm in the iatrogenic setting remain unclear with an increase in pulmonary artery pressure post lobectomy thought to play a role.

CONCLUSIONS: The diagnosis of a pseudoaneurysm is usually serendipitous, as in our case. And there is a lack of significant data or consensus guidelines, still, hemoptysis is recognized as a frequent and life threatening symptom of Pulmonary artery rupture. A pseudoaneurysm though rare, should be considered a diagnostic possibility in patients presenting with hemoptysis who recently underwent an invasive thoracic procedure.

Reference #1: Pulmonary artery pseudoaneurysm after a left upper sleeve lobectomy. Bao M, Zhou Y, Jiang G, Chen C.

Reference #2: Pulmonary Artery Aneurysms and Pseudoaneurysms in Adults Nguyen E, Silva C, Seely J, Chong S, Lee K S, Müller N L

DISCLOSURE: The following authors have nothing to disclose: Bilal Lashari, Zahra Qamar, Faizan Malik, Rajesh Patel

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