Clinical study
The Role of Pulmonary CT Angiography and Selective Pulmonary Angiography in Endovascular Management of Pulmonary Artery Pseudoaneurysms Associated with Infectious Lung Diseases

https://doi.org/10.1016/j.jvir.2007.04.023Get rights and content

Purpose

To determine the value of performing selective angiography based on the findings of pulmonary computed tomographic (CT) angiography for the detection of a pulmonary artery pseudoaneurysm (PAP) associated with infectious lung diseases and to evaluate the usefulness of endovascular management of these PAPs.

Materials and Methods

Over a 6-year period, 11 PAPs were diagnosed in 10 patients (seven men and three women; age, 23–84 years). All patients presented with massive hemoptysis. The underlying diseases were cavitary pulmonary tuberculosis (n = 7), lung abscess (n = 2), and a fungus ball (n = 1). The detection rates of PAP by bronchial/thoracic angiography, main pulmonary angiography, and selective pulmonary angiography were analyzed. When a pseudoaneurysm was detected, feeding artery occlusion was performed with coils or n-butyl cyanoacrylate.

Results

The findings of main pulmonary angiography were contrast agent filling of the pseudoaneurysm (n = 4) and hypoperfusion of the diseased pulmonary segment without contrast agent filling of the pseudoaneurysm (n = 6). The selective angiogram based on pulmonary CT angiography demonstrated five cases of pseudoaneurysm that were not found on the main pulmonary angiogram. Embolization of the pseudoaneurysm was successfully performed in nine of the 10 patients. One patient experienced a rupture of the subsegmental branch of the inferior pulmonary artery during the procedure.

Conclusion

Because main pulmonary angiography alone may fail to demonstrate a pseudoaneurysm, a selective angiogram based on the anatomic information obtained from pulmonary CT angiography is essential for detection of a pseudoaneurysm. In addition, endovascular management of a PAP appears to be a safe and effective treatment.

Section snippets

Materials and Methods

From June 1999 to February 2005, 286 patients underwent bronchial angiography and embolization for hemoptysis. Among these patients, we identified 10 patients (seven men and three women) with a mean age of 51.2 years (age range, 23–84 y) in whom PAPs were found at pulmonary CT angiography. Our institution does not require institutional review board approval for retrospective reviews of patient records or images. There were changes in pulmonary CT angiography equipment and CT scanners used

Results

The findings on the main pulmonary angiograms were contrast agent filling of the pseudoaneurysm (n = 4; 40%) and hypoperfusion of the diseased segment of the lung without contrast agent filling of the pseudoaneurysm (n = 6; 60%). Selective angiograms based on the anatomic information obtained from pulmonary CT angiography demonstrated five cases (50%) of a pseudoaneurysm that had not been identified on the main pulmonary angiograms (cases 5–9; Fig 1). In two patients, the delayed phase of the

Discussion

The mortality rate associated with massive hemoptysis is greater than 50% for patients who are undergo conservative management (4). Postoperative complications are encountered in approximately 50% of these patients and a fatal outcome occurs in 20%, especially when surgery is performed within the first 24 hours after hemoptysis (5). For a patient with massive hemoptysis, the first-line treatment usually recommended includes fiberoptic bronchoscopy to assess the site of bleeding and systemic

References (17)

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None of the authors have identified a conflict of interest.

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