A Case of Bleeding Pulmonary Artery Pseudoaneurysm Successfully Treated with Emergency Microsurgery

Abstract

Pulmonary artery pseudoaneurysm (PAP) is rare. Reported causes of PAP include chest trauma, catheterization, and inflammatory diseases, such as pneumonia and lung abscess. We report a case of bleeding PAP successfully treated with emergency microsurgical reconstruction. A 50-year-old man with T3N1M0 lung cancer of the right upper lobe underwent right upper and middle lobectomy, inferior lobe S6 segmentectomy, and lymph node dissection. An infection of the right residual S6 developed. The inflammation then resulted in PAP. The infected S6 lesion was removed 6 weeks after the first surgery. However, 11 weeks after the first surgery the PAP bled. Although hemostasis was achieved through manual pressure, rebleeding was suspected, and surgery was emergently performed. Firm hemostasis was obtained after debridement and suturing of the lacerated pulmonary artery. A free rectus abdominis musculocutaneous (RAMC) flap with a 22 × 10-cm skin island was then raised and used to cover the pulmonary artery. The flap was used to fill the space that had been occupied by pyothorax. The patient was discharged from the hospital 19 days after the emergent microsurgery. The main treatment approaches for PAPs are catheter embolization and open surgery, but which approach is better is controversial. Surgical treatment was appropriate for our patient because the bleeding vessel was exposed after fenestration. An advantage of reconstruction with a free RAMC flap is the reduced risks of worsening infection and rebleeding, because the space of the defect is filled with tissue having an abundant blood supply and coverage is provided to the area of bleeding.