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Answer: Pulmonary Artery Pseudoaneurysm
Pulmonary artery pseudoaneurysm is a rare complication that often presents with hemoptysis.1,2 The etiology of pulmonary artery pseudoaneurysm are varied. Infectious causes include bacterial pneumonia,2 tuberculosis (Rasmussen aneurysm),3 and mucormycosis.4 Inflammatory diseases, such as Behçet disease, are known to cause pulmonary artery pseudoaneurysms.5,6 They may also arise after blunt or penetrating trauma.7,8 Pulmonary artery pseudoaneurysms have also been attributed to malignancies, such as lung carcinoma,9 sarcoma,10 and bullous emphysema.11 Iatrogenic causes include bronchial artery anhiography12 and pulmonary artery catheterization,13,14 radiofrequency ablation,15 lung resection,16 and pneumonectomy.17 To our knowledge, this is the first case of pulmonary artery pseudoaneurysm reported after VATS.
The diagnosis of pulmonary artery pseudoaneurysms has been simplified with improved computed tomographic angiography, but subselective angiography of the segmental pulmonary arteries provides more detailed anatomical information and potential treatment (Figure 2A).18 Although historically the treatment of pulmonary artery pseudoaneurysms required surgical repair, percutaneous techniques, such as transcatheter coil embolization19,20 (Figure 2B) and stent grafting21 of the main pulmonary arteries, have become the first-line treatment modality.
Figure 2. Subselective angiography demonstrated a pulmonary artery pseudoaneurysm arising from the superior segmental artery of the descending pulmonary artery (A) with successful coil embolization (B) demonstrating absence of contrast-enhanced blood flow in the pseudoaneurysm.
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Correspondence: Stephen J. Huddleston, MD, PhD, Department of Surgery, The Johns Hopkins Hospital, 600 N Wolfe St, Blalock Bldg, Room 618, Baltimore, MD 21287 (firstname.lastname@example.org).
Accepted for Publication: October 11, 2010.
Author Contributions:Study concept and design: Huddleston, Wei Lum, Black, and Meneshian. Acquisition of data: Huddleston, Wei Lum, Black, and Meneshian. Analysis and interpretation of data: Huddleston, Wei Lum, Black, and Meneshian. Drafting of the manuscript: Huddleston. Critical revision of the manuscript for important intellectual content: Huddleston, Wei Lum, and Black. Administrative, technical, and material support: Huddleston. Study supervision: Wei Lum, Black, and Meneshian.
Financial Disclosure: None reported.
Image of the Month—Diagnosis. Arch Surg. 2011;146(11):1332. doi:10.1001/archsurg.2011.283-b
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