Pulmonary Artery Aneurysms: Four Case Reports and Literature Review

Abstract

Aneurysms of the pulmonary arteries (PAs) and trunk are a rare entity. They have been associated with structural cardiac anomalies (especially congenital heart disease), structural vascular anomalies, vasculitis, pulmonary hypertension, and infection, but idiopathic pulmonary artery aneurysms (PAAs) have also been identified. Recently, reports and identification of these clinical entities have increased owing to advances in diagnostic imaging methods such as computed tomography (CT), magnetic resonance imaging (MRI), and echocardiography. However, their natural history has not been extensively studied and remains largely unknown. Here, we present four cases of PAAs (three surgical and one medical) and review the existing literature on the subject. Case Presentations Case 1A 41-year-old woman with a history of diabetes since childhood, hypertension and obesity was noted to have an abnormal electrocardiogram, which led to a cardiac evaluation. She was also noted to have episodes of dyspnea, which were getting more severe. She ultimately had a chest CT, which revealed a dilation of the main PA.The PA measured approximately 5.6 to 6.5 cm in diameter and the aneurismal zone extended from 1 cm distal to the pulmonary valve to the bifurcation of the main PA. The right and left main PAs appeared normal in caliber. Echocardiography revealed a severely dilated main PA and valve, with mild pulmonary insufficiency and which showed an estimated PA systolic pressure of 43 mm Hg. It was decided that the aneurysm should be removed and repaired surgically. MRI confirmed the findings of the echo and the CT scan.A standard median sternotomy was performed and the patient was placed on cardiopulmonary bypass. Cross-clamp time was 41 minutes and the lowest core temperature was 28°C. The PAA (►Fig. 1) was resected, and the right and left PAs were mobilized. The repair was performed primarily to reconstruct the PA. Keywords► pulmonary artery ► aneurysm AbstractAneurysms of the pulmonary artery are proven to be a very rare entity. Association with structural cardiac anomalies, structural vascular anomalies, pulmonary hypertension, vasculitis, and infection has been noted. Surgical intervention of symptomatic aneurysms is recommended. A more detailed study of the natural history of these aneurysms is needed. Here, we report four cases of pulmonary artery aneurysms as well as a brief review of the literature existing on this subject. The first case is of a 41-year-old woman with the aneurysm located 1 cm distal to the pulmonary valve extending to the bifurcation of the main pulmonary artery. The second case is of a 76-year-old woman with a large aneurysm of the main pulmonary artery and the left pulmonary artery. The third case is of a 61-year-old woman with an aneurysm of the common pulmonary artery and right pulmonary artery. The fourth case is of a 28-year-old woman with a 5-cm symptomatic aneurysm extending from the valve up to the pulmonary bifurcation. Surgical excision and reconstruction was ordered for cases 1, 2, and 4.

Pulmonary artery aneurysm rupture

“…3 The most worrying and potentially fatal manifestation is hemoptysis, which occurs following an aneurysm rupture. 4 In this case, the ruptured aneurysm manifested as a massive hemothorax through the thoracic surgical wound.…”

Expansive pulmonary artery aneurysm in an IV drug user

“…Pulmonary artery aneurysms (PAAs) are defined as dilatation of the vessel beyond 4 cm in diameter and are classified as central (80%) or peripheral (20%) 1. Common causes of PAAs are pulmonary hypertension, congenital heart disease, pulmonary stenosis, trauma and vasculitis 2 3.…”

“…Associated symptoms may include haemoptysis or dyspnoea as in our case. Pulmonary angiograms are the gold standard for diagnosis and cardiac catheterisation is often used to confirm the underlying aetiology 1 2. Treatments include medical therapy alone or surgery, which is usually recommended for patients who are symptomatic or have aneurysms >6 cm in diameter 1…”

Pulmonary artery aneurysms: Preoperative, intraoperative, and postoperative findings

“…13,[18][19][20] Most studies published to date are case reports with few patients. 8,11,13,18,21,22 In this report, we describe our experience in 6 patients undergoing PAA repair at our institution. In this report, we describe our experience with PAAs requiring surgical repair.…”