Traumatic pulmonary artery pseudoaneurysm simulating pulmonary embolism

Wp, Dillon; Taylor, A. E.; Mineau, DE; Datz, Frederick L.

doi:10.2214/ajr.139.4.818

Cited by 22 publications

(10 citation statements)

References 5 publications

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“…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].…”

Section: Discussionsupporting

confidence: 68%

“…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].…”

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confidence: 99%

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

et al. 2009

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Pulmonary artery pseudo-aneurysm (PAPA) resulting from chest trauma is uncommon. 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].The development and improvement of imaging techniques, especially multislice CT scan, have permitted the diagnosis of 'new injuries' in trauma patients. These injuries identified with modern diagnostic technology may represent a challenge to the surgeon, who has to determine or characterise their nature and apply the appropriate management.Here, we report two cases of pulmonary vessel pseudo-aneurysm in blunt-trauma patients who were admitted to our emergency surgical service (ESS) and were successful treated non-operatively. Case 1A 37-year-old man was involved in a collision with a car while riding a bicycle and arrived at our ESS without any additional information. The patient was not alert upon his admission to the emergency room. An orotracheal intubation was performed. The chest physical examination showed multiple thoraco-abdominal excoriations, and bilateral vesicular murmur was present with diffuse bruises. The cardiocirculatory system was normal on physical examination, and the focussed assessment with sonography for trauma (FAST) showed fluid in hepatorenal and pelvic fields. Pelvic and rectal examination was normal, and the urine was clear. The Glasgow Coma Scale (GCS) score was 8 before sedation. Right tibia and fibula fractures (Gustilo grade IIIa) were observed.A cranial/thoracic CT scan showed multiple facial fractures (nasal, maxillary, right zygomatic and bilateral orbital), as well as a small right haemo-pneumothorax, a right PAPA measuring 24 mm Â 21 mm Â 23 mm (23-mm extension) and a right inferior pulmonary vein pseudo-aneurysm measuring 10 mm (Fig. 1). An abdominal/ pelvic CT showed a small right hepatic lobe laceration, a right adrenal haematoma and small liquid collections in hepatic and pelvic fields.The patient underwent external fixation of tibia and fibula fractures performed by the orthopaedic surgery group. Facial fractures as well as the thoracic and abdominal lesions were managed non-operatively. The patient received care in the trauma intensive care unit (ICU), where he required continuous noradrenalin infusion for 3 days. Eight days after admission, the patient had internal fixation of tibia and fibula fractures. No specific treatment for the pseudo-aneurysm was performed. A repeated CT scan performed 22 days after admissio...

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Section: Discussionsupporting

confidence: 68%

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confidence: 99%

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

et al. 2009

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“…1 The earliest detection of pulmonary artery pseudoaneurysm status after trauma has been reported at 1 week, coincidentally blunt in origin. 9 That case was of a pedestrian who was struck by an automobile and who was hemodynamically stable at presentation, with initial chest x-ray showing a widened mediastinum. Initial arch aortography was normal; however, a pulmonary arteriogram was subsequently not performed.…”

Section: Discussionmentioning

confidence: 99%

Immediate Diagnosis and Nonoperative Treatment of a Pulmonary Artery Pseudoaneurysm after Blunt Traumatic Injury

Reade

Jenkins

Bard

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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P ulmonary artery pseudoaneurysms after traumatic injury are a very rare occurrence; only 14 cases have been reported in the literature. Blunt traumatic pulmonary artery pseudoaneurysms constitute a small number of these cases; only three cases have been reported to date. In every reported case of traumatic pulmonary artery pseudoaneurysm since 1920, the pseudoaneurysm was repaired operatively using local resection (aneurysectomy), ligation of vessels, lobectomy, or embolization. 1,2 We report a case of blunt traumatic main pulmonary artery pseudoaneurysm detected on initial computed tomography (CT) that was treated nonoperatively. To our knowledge, this is the first reported pulmonary artery pseudoaneurysm detected immediately on trauma assessment and also the first reported patient with traumatic pulmonary artery pseudoaneurysm treated nonoperatively that survived. CASE REPORTA 57-year-old man who was involved in a head-on motor vehicle collision as the unrestrained passenger presented awake and alert with multiple facial lacerations and unknown loss of consciousness. The patient denied any known drug allergies and took no medications. Medical history was significant for hypertension and diabetes mellitus and there was no surgical history. The patient did admit to regular alcohol and marijuana use but denied any significant family medical history. The primary survey was unremarkable. The airway was patent, Glasgow Coma Scale score was 15, and the patient seemed in no apparent distress. No additional injuries were noted and motor and sensory exams were normal. The usual resuscitation maneuvers were employed.Routine pelvis and chest x-rays were obtained. The chest film revealed minimal widening of the superior mediastinum (measured as 10 cm of 38.5 cm chest width) and tortuosity of the thoracic aorta. The pelvic film was negative. The patient had helical multidetector CT imaging without contrast of the head, face, and c-spine. The head CT was negative for intracranial injury, whereas the CT scan of the face showed minimal medial displacement of the left zygoma. In addition, helical multidetector CT imaging of the chest with intravenous contrast was obtained in addition to the usual abdomen/ pelvis CT with oral and intravenous contrast. The chest CT was added because of widened mediastinum and loss of aortic knob. The chest CT revealed a lobulated contour of the main pulmonary artery with an 18-mm probable pseudoaneurysm along the left superior margin of the main pulmonary artery (Fig. 1). A small amount of mediastinal hematoma was seen although the aorta and great vessels of the arch were intact. There was no evidence of pericardial effusion, pleural effusion, or pneumothorax. The abdomen/pelvis CT scan revealed minimal free fluid in the left upper quadrant inferior to the spleen and in the left paracolic gutter with the absence of identifiable solid organ injury.The patient was then taken for pulmonary angiography, which also revealed a lobulated appearance with a focal contour abnormality along the left anterio...

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“…Totally absent perfusion of a complete lung is a rare finding, and one should be especially aware of congenital vascular abnormalities Pulmonary veno-occlusive disease [39] Fibrotic sarcoid [42] Perfusion defect with normal ventilation Acute pulmonary embolism [6-8, 19, 33] Old pulmonary thromboembolism [44,45] Atelectasis [48] Metastatic lung disease [49] (Microscopic) tumour embolism [51,52] Post radiotherapy [54] Haemangioendotheliomatosis [56] Traumatic pulmonary artery pseudoaneurysm [58] Air embolism [61] Idiopathic pulmonary fibrosis [63,64] Oesophageal hiatus hernia [65] Positive end expiratory pressure ventilation [67] Diaphragm paralysis [69] Mitral valve disease [71] Dogworm infestation [33] Congenital vascular abnormalities [36][37][38] Tumours in the hilar region [40,41] Histoplasmosis [43] Emphysema [46,47] Pneumonia [33,42] Sarcoidosis [49] Lymphangitis carcinomatosis [50] Intravenous drug abuse [53] Pulmonary artery sarcoma [49,55] Systemic arterial supply [57] Pulmonary contusion [59,60] Takayasu's arterities [49,62] Histoplasmosis [43] Intrathoracic stomach …”

Section: High Probability Perfusion-ventilation Lung Scanmentioning

confidence: 99%

“…Finally, such patients are often trauma victims whose primary trauma can cause perfusion-ventilation mismatches (e.g. air embolism, lung contusion and pseudoaneurysm) [33,45,[58][59][60][61].…”

Section: High Probability Perfusion-ventilation Lung Scanmentioning

confidence: 99%

The value of lung scintigraphy in the diagnosis of pulmonary embolism

et al. 1993

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The role of lung scintigraphy in the diagnostic management of patients with clinically suspected pulmonary embolism is reviewed. Evidence is provided that a normal perfusion scan excludes clinically relevant pulmonary embolism, and that a high probability lung scan, defined as a segmental perfusion defect with locally normal ventilation, sufficiently confirms the presence of pulmonary embolism in the majority of these patients. Furthermore, this review assesses the possibility of non-invasive tests for the diagnosis or exclusion of venous thromboembolic disease as a means of avoiding pulmonary angiography in patients with lung scan outcomes that are neither normal nor high probability.

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Traumatic pulmonary artery pseudoaneurysm simulating pulmonary embolism

Cited by 22 publications

References 5 publications

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

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

Immediate Diagnosis and Nonoperative Treatment of a Pulmonary Artery Pseudoaneurysm after Blunt Traumatic Injury

The value of lung scintigraphy in the diagnosis of pulmonary embolism

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