Pulmonary artery pseudoaneurysm secondary to COVID-19 treated with endovascular embolisation

Abstract

Pulmonary artery pseudoaneurysms are uncommon and can cause severe, life-threatening haemoptysis. We present a case of a 74-year-old gentleman who was being treated for COVID-19 pneumonitis and a concomitant segmental pulmonary artery thrombus with conventional treatment and anticoagulation. The patient developed significant haemoptysis during admission. A repeat computed tomography pulmonary angiogram revealed an 8 mm left upper lobe pulmonary artery pseudoaneurysm. Anticoagulation was withheld and the pseudoaneurysm was successfully treated with endovascular embolisation with an Amplatzer® IV plug, leading to resolution of the haemoptysis. To our knowledge this is the first case of a pulmonary artery pseudoaneurysm secondary to COVID-19.

Pulmonary Artery Pseudoaneurysm in COVID-19-Associated Pulmonary Mucormycosis: Case Series and Systematic Review of the Literature

“…Hemoptysis is unusual in coronavirus disease (COVID-19), [ 8 ] and has been observed with pulmonary embolism or invasive pulmonary aspergillosis. [ 9 – 11 ] Bronchial circulation (contributes to 2% of the blood supply to the lungs) accounts for most cases of hemoptysis. Pulmonary artery as a source of bleeding is uncommon, easily missed, and challenging to manage.…”

Endovascular Repair of an Iatrogenic Pulmonary Artery Pseudoaneurysm

“… 4 The treatment modality is determined on the basis of the cause, the patient’s risk factors, comorbidities, anatomical location, and technical feasibility. 5 …”

Pulmonary pseudoaneurysm presented as a lung nodule after recovering from Covid‐19 pneumonia

“…The vessel wall is destroyed and replaced by granulation tissue, resulting in segmental dilatation. 2 , 5 In addition, several cases have reported PAPs due to endovascular seeding from septic emboli associated with confirmed infective endocarditis cases. 1 , 3 , 8 …”

“…CTA is currently the investigation of choice in which a focal dilatation of a branch of pulmonary artery is performed. 2 , 5 It can also detect peripheral PAPs for which a pulmonary angiography alone cannot be used due to the presence of thrombus or slow blood flow inside the PAPs. 2 , 9 The current treatment for PAPs involves endovascular occlusion of the feeding vessel using coils, plugs or stents.…”