Traumatic pulmonary artery injury: a review of the recent literature

Abstract

Pulmonary artery injury (PAI) is rare, lethal clinical entity. Traumatic PAI is anatomically classified into transection/ rupture/laceration, pseudoaneurysm, dissection and fistula. In addition, traumatic PAI is clinically classified into two major categories: iatrogenic and non-iatrogenic, depending on the mechanism of the trauma. The frequency, clinical symptoms and treatment differ between the two clinical categories. If PAI can be managed appropriately and promptly in patients without cardiac arrest, the patient may be saved, as PAI can be easily controlled with appropriate procedures due to the low pressure in the PA circulation.

Pulmonary Artery Dissection Post-blunt Thoracoabdominal Trauma

“…Most reported traumatic injuries of the pulmonary artery have occurred secondary to blunt or penetrating chest trauma and result in rupture, pseudoaneurysm or both. 1 , 2 The majority of patients with PAD are diagnosed post-mortem due to the condition manifesting as cardiogenic shock or sudden death when the dissection progresses rapidly and results in rupture. 3 However, a recent review of the literature has noted over 90% of traumatic, non-iatrogenic pulmonary artery injuries of 50 reported since 1990 have resulted in survival of the patient.…”

“… 3 However, a recent review of the literature has noted over 90% of traumatic, non-iatrogenic pulmonary artery injuries of 50 reported since 1990 have resulted in survival of the patient. 2 Diagnosis in living patients has been made based on intraoperative findings or pulmonary arteriography. 3 Clinical suspicion for a PAD should include: chest pain, cyanosis, pulmonary arterial hypertension and dyspnea.…”

“…Although there is no consensus on management due to the variation of mechanism of injury and rarity of the condition, the mainstay of treatment for traumatic PADs is a surgical or interventional approach. 2 …”

Thoracic Trauma, Nonaortic Injuries

“…Injury to the pulmonary artery (PA) can occur due to blunt chest trauma or more commonly iatrogenically due to PA catheters, also known as Swan-Ganz catheters. 32 Estimated incidence of PA injury due to PA catheterization is low, between 0.01 and 0.47%. Injury can result in dissection or rupture; however, unlike aortic dissections, PA dissections quickly progress and rupture.…”

“…Long-term sequelae of PA injury include pseudoaneurysm formation and potential rupture, which can occur up to 60 years following the injury, and arterial fistula formation. 32 PA rupture secondary to PA catheters can be deadly with an average mortality rate of 50% and a mortality rate as high as 75% in anticoagulated patients. Although PA rupture is typically treated surgically, it has been successfully managed by embolization or stent graft placement.…”