Pulmonary Artery Pseudoaneurysm: A Rare Cause of Fatal Massive Hemoptysis
Pulmonary artery pseudoaneurysm (PAPA), an uncommon complication of pyogenic bacterial and fungal infections and related septic emboli, is associated with high mortality. The pulmonary artery (PA) lacks an adventitial wall; therefore, repeated endovascular seeding of the PA with septic emboli create...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Case Reports in Pulmonology |
| Online Access: | http://dx.doi.org/10.1155/2018/8251967 |
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| author | Himaja Koneru Sreeja Biswas Roy Monirul Islam Hesham Abdelrazek Debabrata Bandyopadhyay Nikhil Madan Pradnya D. Patil Tanmay S. Panchabhai |
| author_facet | Himaja Koneru Sreeja Biswas Roy Monirul Islam Hesham Abdelrazek Debabrata Bandyopadhyay Nikhil Madan Pradnya D. Patil Tanmay S. Panchabhai |
| author_sort | Himaja Koneru |
| collection | DOAJ |
| description | Pulmonary artery pseudoaneurysm (PAPA), an uncommon complication of pyogenic bacterial and fungal infections and related septic emboli, is associated with high mortality. The pulmonary artery (PA) lacks an adventitial wall; therefore, repeated endovascular seeding of the PA with septic emboli creates saccular dilations that are more likely to rupture than systemic arterial aneurysms. The most common clinical presentation of PAPA is massive hemoptysis and resultant worsening hypoxemia. Computed tomography angiography is the preferred diagnostic modality for PAPA; typical imaging patterns include focal outpouchings of contrast adjacent to a branch of the PA following the same contrast density as the PA in all phases of the study. In mycotic PAPAs, multiple synchronous lesions are often seen in segmental and subsegmental PAs due to ongoing embolic phenomena. The recommended approach for a mycotic PAPA is prolonged antimicrobial therapy; for massive hemoptysis, endovascular treatment (e.g., coil embolization, stenting, or embolization of the feeding vessel) is preferred. PAPA resection and lobectomy are a last resort, generally reserved for patients with uncontrolled hemoptysis or pleural hemorrhage. We present a case of a 28-year-old woman with necrotizing pneumonia from intravenous drug use who ultimately died from massive hemoptysis and shock after a ruptured PAPA. |
| format | Article |
| id | doaj-art-15c8b546f4524bf69821781d3c9a8b88 |
| institution | Kabale University |
| issn | 2090-6846 2090-6854 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Pulmonology |
| spelling | doaj-art-15c8b546f4524bf69821781d3c9a8b882025-02-03T06:12:16ZengWileyCase Reports in Pulmonology2090-68462090-68542018-01-01201810.1155/2018/82519678251967Pulmonary Artery Pseudoaneurysm: A Rare Cause of Fatal Massive HemoptysisHimaja Koneru0Sreeja Biswas Roy1Monirul Islam2Hesham Abdelrazek3Debabrata Bandyopadhyay4Nikhil Madan5Pradnya D. Patil6Tanmay S. Panchabhai7Department of Thoracic Medicine, Geisinger Medical Center, Danville, PA, USANorton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USADepartment of Thoracic Medicine, Geisinger Medical Center, Danville, PA, USANorton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USADepartment of Thoracic Medicine, Geisinger Medical Center, Danville, PA, USANorton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USATaussig Cancer Institute, Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USANorton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USAPulmonary artery pseudoaneurysm (PAPA), an uncommon complication of pyogenic bacterial and fungal infections and related septic emboli, is associated with high mortality. The pulmonary artery (PA) lacks an adventitial wall; therefore, repeated endovascular seeding of the PA with septic emboli creates saccular dilations that are more likely to rupture than systemic arterial aneurysms. The most common clinical presentation of PAPA is massive hemoptysis and resultant worsening hypoxemia. Computed tomography angiography is the preferred diagnostic modality for PAPA; typical imaging patterns include focal outpouchings of contrast adjacent to a branch of the PA following the same contrast density as the PA in all phases of the study. In mycotic PAPAs, multiple synchronous lesions are often seen in segmental and subsegmental PAs due to ongoing embolic phenomena. The recommended approach for a mycotic PAPA is prolonged antimicrobial therapy; for massive hemoptysis, endovascular treatment (e.g., coil embolization, stenting, or embolization of the feeding vessel) is preferred. PAPA resection and lobectomy are a last resort, generally reserved for patients with uncontrolled hemoptysis or pleural hemorrhage. We present a case of a 28-year-old woman with necrotizing pneumonia from intravenous drug use who ultimately died from massive hemoptysis and shock after a ruptured PAPA.http://dx.doi.org/10.1155/2018/8251967 |
| spellingShingle | Himaja Koneru Sreeja Biswas Roy Monirul Islam Hesham Abdelrazek Debabrata Bandyopadhyay Nikhil Madan Pradnya D. Patil Tanmay S. Panchabhai Pulmonary Artery Pseudoaneurysm: A Rare Cause of Fatal Massive Hemoptysis Case Reports in Pulmonology |
| title | Pulmonary Artery Pseudoaneurysm: A Rare Cause of Fatal Massive Hemoptysis |
| title_full | Pulmonary Artery Pseudoaneurysm: A Rare Cause of Fatal Massive Hemoptysis |
| title_fullStr | Pulmonary Artery Pseudoaneurysm: A Rare Cause of Fatal Massive Hemoptysis |
| title_full_unstemmed | Pulmonary Artery Pseudoaneurysm: A Rare Cause of Fatal Massive Hemoptysis |
| title_short | Pulmonary Artery Pseudoaneurysm: A Rare Cause of Fatal Massive Hemoptysis |
| title_sort | pulmonary artery pseudoaneurysm a rare cause of fatal massive hemoptysis |
| url | http://dx.doi.org/10.1155/2018/8251967 |
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