Pulmonary artery pseudoaneurysm after a left upper sleeve lobectomy

Abstract

A 55-year-old man was re-admitted for persistent hemoptysis and high fever three weeks after an initial left upper sleeve lobectomy for a central squamous lung cancer tumor. Pulmonary artery pseudoaneurysm and pulmonary infection were confirmed by multidetector computed tomography angiography and subsequent emergency completion pneumonectomy. The development of pulmonary artery pseudoaneurysm, secondary to post-operative pulmonary infection and pulmonary vascular manipulation, is rare and prompt surgical manipulation is mandatory.

Pseudoaneurysm of pulmonary artery: rare complication of systemic chemotherapy

“…Because of higher tendency of getting ruptured, on rare occasions these present with hemorrhages and other catastrophic events like intrapulmonary hemorrhage, hemothorax, or intrabronchiolar hemorrhage. Idiopathic pulmonary artery pseudoaneurysm is more commonly found in elderly females, besides that no other demographic event has been attributed to pseudoaneurysm formation in pulmonary vasculature 7 . Pulmonary artery pseudoaneurysm are seen either after traumatic event, tuberculosis, pneumonia, vasculitis (few common ones: Behcet's syndrome and Hughes–Stovin syndrome which is characterized by recurrent thrombophlebitis and pulmonary artery aneurysm) or congestive heart failure.…”

“…There are a handful of cases with invasive cancer presenting with pseudoaneurysm of pulmonary vasculature which resolve after the treatment of cancer with systemic chemotherapy 1 , 2 , 4 , 5 . Few case reports mention the occurrence of pseudoaneurysm of pulmonary vasculature after local invasive procedures like placement of Swan–Ganz catheter or after sessions of local chemotherapy 3 , 7 , 8 . Few cases mention adriamycin as the most commonly associated chemotherapy agent with pseudoaneurysm especially in patients undergoing transarterial chemoemobilzation (TACE) for hepatocellular carcinoma 6 – 8 , 10 .…”

“…Computerized tomography with contrast enhancement has high sensitivity of diagnosing pseudoaneurysm and also it gives a precise location of aneurysm for deciding the modality of treatment required. The common presentations on contrast enhanced computerized tomography (CECT) are round enhancement isodense with central pulmonary artery, with central enhancement and no precontrast enhancement are diagnostic of pulmonary artery pseudoaneurysm 1 , 7 . The upper limit of normal diameter of the main pulmonary artery on CT is 29 mm and of the right interlobar artery is 17 mm 11 .…”

“…Focal dilatation of pulmonary artery can be seen in tuberculosis, pulmonary vascular infections, trauma, and vasculitis. It can also be observed after intra-arterial chemotherapy and Swan–Ganz catheter placement 7 . There is some evidence that erosion of vessel wall by tumor can result in a pseudoaneurysm of branches of the pulmonary artery.…”

A Case of Bleeding Pulmonary Artery Pseudoaneurysm Successfully Treated with Emergency Microsurgery

“…Bao et al have reported a PAP following left upper sleeve lobectomy for a central squamous cell lung cancer. 2 The PAP was attributed to both inflammation and iatrogenic PA trauma during lobectomy. Therefore, an operative procedure can be a contributing cause of PAP.…”