Pulmonary Artery Pseudoaneurysm

A 68-year-old woman
presented to the thoracic surgery clinic for evaluation of a large left lower
lobe mass. Six months prior, she had undergone attempted right-heart-catheterization
at an outside hospital, which was aborted due to an acute pulmonary hemorrhage.
Physical examination revealed decreased breath sounds at the left lung base.
Computed tomography revealed an enhancing 8.9 cm mass (Figure 1A, arrow)
arising from the left lower lobe segmental pulmonary artery (Figure 1B,
arrowhead), compatible with a pseudoaneurysm. Iatrogenic damage to the
pulmonary artery and its branches is a known complication of percutaneous
interventional procedures, such as Swan-Ganz catheterization (1). Small
pseudoaneurysms can frequently be managed with a transcatheter approach
utilizing coil-embolization or thrombin injection. However, larger lesions may
require surgical intervention (2). The patient underwent left thoracotomy and
left lower lobectomy. She was seen in the clinic following hospital discharge
and was recovering well without complications (Figure 2).

References

1. Shah MR, Hasselblad V, Stevenson LW, et al. Impact
of the pulmonary artery catheter in critically ill patients: meta-analysis of
randomized clinical trials. JAMA. 2005;294(13):1664-1670.

2. Lafita V, Borge MA, Demos TC. Pulmonary artery pseudoaneurysm: etiology,
presentation, diagnosis, and treatment. Semin Intervent Radiol. 2007;24(1):119-123.