Pulmonary Arteriovenous Fistula, Pulmonary Artery Aneurysm, and Other Vascular Changes of the Lung From Penetrating Trauma

Abstract

Pulmonary arteriography was performed in 22 patients with penetrating injury of the lung(s) within the first 72 post-injury hours and no vascular lesion directly attributable to the injury was found. Pulmonary arteriovenous fistula or pulmonary artery aneurysm secondary to penetrating pulmonary injury, are extremely rare lesions, but they should be suspected in a patient with penetrating wound of the chest with signs and symptoms of pulmonary arteriovenous fistula or with chronic residual well circumscribed density on chest roentgenogram. The treatment of these lesions should be excision of the lesion with preservation of the lung, whenever possible, or resection of the involved lobe.

Pulmonary vessel pseudo-aneurysm after blunt traumatic injury: A report of two cases

“…Most of these 17 reported cases were managed surgically with elevated morbidity and mortality [1][2][3][4][5][6]8,10,11,16,17]. The results of the conservative (non-surgical) management employed in the two cases of PAPA resulting from blunt trauma reported herein are consistent with the reports of other asymptomatic pseudoaneurysm that were diagnosed during the initial assessment [14].…”

“…In the other 16 cases reported in the reviewed literature, 12 resulted from penetrating trauma and four from blunt trauma. Most were symptomatic, the most prevalent symptoms being haemoptysis, hypoxia, dyspnoea and pain [5,8,[11][12][13]15,17]. Improvement in diagnostic imaging techniques has allowed identification of asymptomatic traumatic lesions, such as PAPA, at primary evaluation.…”

“…Seventeen cases have been described in the literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]: 12 of these resulted from penetrating injuries [1,2,4,5,7,8,12,13,[15][16][17], 4 from blunt injuries [3,9,11,14], and 1 case that involved penetrating chest trauma with simultaneous pulmonary artery and pulmonary vein pseudo-aneurysm [10].In 2006, Reade et al first described the case of blunt traumatic main PAPA, detected on initial computed tomography (CT) scan, that was treated non-operatively [14]. In every reported case, the traumatic PAPA was repaired operatively by means of local resection (aneurysectomy), ligation of vessels, lobectomy or embolisation [5,15].…”

Traumatic Arterio-Venous Pulmonary Pseudoaneurism

“…In a prospective study on 500 patients, it was proven that the incidence of rupture and hemorrhage after the Swan-Ganzcatheter is 0.2% [6]. PN Symbas et al [7] performed pulmonary arteriography in 22 patients with penetrating injury of the lung(s) within the first 72 post-injury hours found no vascular lesion directly attributable to the injury. They suggested that the penetrating pulmonary vascular injury, once the bleeding stops, usually heals without residual abnormality and only in extremely rare cases, pulmonary arterio venous fistula or pulmonary artery aneurysm develops.…”

“…Chest radiographs may show nonspecific focal lung consolidation, a solitary pulmonary nodule, or early consolidation evolving to a nodule or mass [11]. Although occurrence is rare it should always be considered in a patient with a penetrating wound of the lung and a persistent well circumscribed radiodensity in the lung at the site of injury [7]. The gold standard for the diagnosis of PAAs has been pulmonary angiography.…”