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Clinical Info/Reason for examClinical Info/Reason for
examClinical Info/Reason for examClinical Info/Reason for exam• 76
years female brought to ER with left lower quadrant y g q
pain and nausea and vomiting for four days.• PMH- HTN,
ex-smoker
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Images (use multiple slides ifImages (use multiple slides if
necessary)
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Diagnosis
Pulmonary Artery AneurysmPulmonary Artery Aneurysm
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Pulmonary artery aneurysmPulmonary artery aneurysm• very rare, 1
in 14000 in autopsies. • Aneurysm is defined when pulmonary artery
dilatation > 4 cm • Etiology- > 50% - Congenital cardiac
anomalies, most frequently
absent pulmonary valve syndromes or patent ductus arteriosus
with t i l t i l t l d f t hi h i t d ithatrial or ventricular
septal defects which are associated with
pulmonary hypertensionInfections (bacterial or mycotic
endocarditis, syphilis, tuberculosis)Arteriosclerosis degenerative
changes of the elastic media cysticArteriosclerosis, degenerative
changes of the elastic media, cystic
medial necrosis. Vasculitis,HypertensionHypertension, Trauma and
Arteriovenous fistula.
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Pulmonary artery aneurysmPulmonary artery aneurysm• Symptoms-
asymptomatic or nonspecific (dyspnea on y p y p p ( y p
exertion, fever or cough) and are referred with the suspicion of
a vascular dilatation seen on CRX. However sometimes hemoptysis can
also be aHowever, sometimes hemoptysis can also be a catastrophic
presenting symptom which may lead to death.
• Pulmonary artery aneurysms are located most frequently in
theright lower lobar arteries followed by the right and leftright
lower lobar arteries followed by the right and left
mainpulmonary arteries.p y
• Complications- dissection, embolism, rupture,compression of
the surrounding tissues.
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ManagementManagement
• There are no clear guidelines regarding surgical g g g
gindication for its treatment. Conservative treatment is still
advocated when there is no left to right shunt or significant
pulmonary arterial hypertension or forsignificant pulmonary
arterial hypertension or for idiopathic cases. Patients symptomatic
from dyspnea, chest pain, hemoptysis need surgical intervention
f fbecause such findings may be indicators of impending
rupture.
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References
1. Mann P, Seriki D, Dodds PA. Embolism of an idiopathic
pulmonary, , p p yartery aneurysm. Heart 2002; 87: 135.2. Imazio M,
Cecchi E, Giammaria M, Pomari F, Tabasso MD, Ghisio A,et al. Main
pulmonary aneurysm: A case report and review of theliterature. Itl
Heart J 2004; 5: 232-7.;3. Tunaci M, Ozkorkmaz B, Tunaci A, Gul A,
Engin G, Acunas B. CTfindings of pulmonary artery aneurysms during
treatment forBehçet’s disease. Am J Roentgenol 1999; 172: 729-33.4.
Chetty KG, McGovern J, Mahutte C. Hilar mass in a patient withchest
pain. Chest 1996; 109: 1643-4.5. Dayioglu E, Sever K, Basaran M,
Kafali E, Ugurlucan M, Sayin OA, etal. Idiopathic pulmonary artery
aneurysm. Int J Thorac CardiovascSurg 2004; 20: 140-1.6. Lupi E,
Dumont C, Tejada VM, Horwitz S, Galland F. A radiologicindex of
pulmonary arterial hypertension. Chest 1975; 68: 28-31.7. Sharma S.
Pulmonary Hypertension, Secondary. EMedicine. (updateJune 23,
2006). Available from: URL: http://www.emedicine.com/med/
