Clinical studyThe Role of Pulmonary CT Angiography and Selective Pulmonary Angiography in Endovascular Management of Pulmonary Artery Pseudoaneurysms Associated with Infectious Lung Diseases
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
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Cited by (41)
An unusual case of hemoptysis: Pulmonary artery pseudoaneurysm secondary to a lung abscess
2021, Respiratory Medicine Case ReportsCitation Excerpt :However, surgery should be considered for patients with active pleural hemorrhage, recurrent hemoptysis, and active infections that are refractory to antibiotic treatment [17]. In contrast to surgery, TAE tends to be a safe and noninvasive procedure, even in urgent situations, as MDCTA can accurately identify PAPs and their associated feeding arteries; MDCTA can also be used to guide the TAE procedure [18]. TAE can also be performed to control hemorrhage in cases where surgery is to be performed [19,20].
Pulmonary artery pseudoaneurysm secondary to COVID-19 treated with endovascular embolisation
2021, European Journal of Radiology OpenEsophagopulmonary fistula causing pulmonary arterial pseudoaneurysms and massive hemoptysis
2020, Radiology Case ReportsCitation Excerpt :CT angiography may be superior to catheter angiography in detection of PA pseudoaneurysms, as thrombus, peripheral location, vascular tissue flaps acting as valves, and slow blood flow within the pseudoaneurysm may all impede visualization on digital subtraction angiography [9]. Maximal intensity projections and 3-dimensional reconstructions may be helpful for endovascular or surgical planning [9]. Treatment of PA pseudoaneurysms include coil embolization across the arterial defect, endovascular stent-graft repair, or surgical resection [10–13].
ACR Appropriateness Criteria® Hemoptysis
2020, Journal of the American College of RadiologyCitation Excerpt :Although all of these patients were initially treated with BAE, 7 out of 8 patients required additional pulmonary artery embolization. Shin et al [24] identified 10 patients with pulmonary artery pseudoaneurysms (PAPs) out of 286 patients presenting with massive hemoptysis undergoing BAE. These authors reported a pulmonary artery embolization success rate above 90%.
Outcomes of Pulmonary Artery Embolization and Stent Graft Placement for the Treatment of Hemoptysis Caused by Lung Tumors
2018, Journal of Vascular and Interventional RadiologyCitation Excerpt :The hemodynamic degradation was so fast and extensive that embolization could not be performed. This is a reminder that this is a serious condition and that patients and their families should be kept informed of the life-threatening prognosis (10–15). CT has a major role in identifying pulmonary artery abnormalities (12,15).
None of the authors have identified a conflict of interest.