PULMONARY ARTERY PSEUDOANEURYSM DISGUISED AS MALIGNANT LESION

Abstract

SESSION TITLE: Fellows Procedures Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pulmonary artery pseudoaneurysms (PAPs) are rare, associated with cardiovascular disease, and have potentially life-threatening complications such as exsanguination. They may be iatrogenic, or related to trauma, infection, neoplasm, pulmonary hypertension, or vasculitis. Patients with PAPs may be asymptomatic or present with hemoptysis. CASE PRESENTATION: Patient is a 67-year-old female with a significant medical history of PAF, HFrEF, DM, HTN, breast cancer s/p lumpectomy, & colon cancer s/p partial colectomy was admitted for generalized weakness & shortness of breath on exertion. She was admitted about two weeks prior for pneumonia and streptococcus agalactiae bacteremia, developed new onset atrial fibrillation, and was discharged home on Eliquis and Augmentin. Vitals were: T 98 F, BP 110/50, HR 80, RR 16, O2 sat 98 % on RA. Physical exam was unremarkable except trace pitting edema bilaterally. Lab studies including metabolic panel, cell counts, & troponins were unremarkable. BNP was elevated at 290. Echocardiogram showed EF 35%, moderate LVH paradoxical septal motion, posterior mitral valve leaflet prolapse, & moderate circumferential pericardial effusion. Chest x-ray was negative for any infiltrate & CT scan of the chest without contrast showed a right lower lung lobe opacity suspicious for malignancy Her symptoms were thought to be as a result of multifactorial etiologies including possible underlying pneumonia & exacerbation of CHF. Patient was started on broad spectrum antibiotics. Patient was scheduled for CT chest angiogram with IV contrast before proceeding with a biopsy of the right lower lobe mass, which in turn showed a 3 cm pseudoaneurysm with connection to the branch of right lower lobe pulmonary artery. Following this discovery on imaging studies, patient underwent IR-guided ablation & coiling. The first attempt at embolization was aborted after hemodynamically significant extravasation from the right lung was noted after angiographic runs. Patient was intubated for airway protection. While intubated, patient underwent a second successful attempt of IR-guided procedure. Eventually she was extubated and discharged home. DISCUSSION: Pulmonary Pseudoaneurysm (PA) is rare and potentially life threatening. It may be idiopathic or traumatic, infection, primary or metastatic lung neoplasm, Pulmonary HTN, or vasculitis. Most cases are asymptomatic, but may present with dry cough & hemoptysis. MDCT angiogram of the chest remains the investigation of choice in the diagnosis of PA. These cases are managed with Urgent endovascular procedure (Coil Embolization) or Surgery [ Open thoracotomy and aneurysm resection with lobectomy for involved lobes] CONCLUSIONS: Pulmonary artery pseudoaneurysms should be on the differential diagnosis for any lung mass or nodule. Prior to obtaining a biopsy of a suspected lung mass or nodule, patients should always undergo a CT chest with IV contrast. Reference #1: Pulmonary Artery Pseudoaneurysms: Clinical Features and CT Findings Ying Chen1, Matthew D. Gilman1, Kathryn L. Humphrey2, Gloria M. Salazar1, Amita Sharma1, Ashok Muniappan3, Jo-Anne O. Shepard1 and Carol C. Wu1 Reference #2: E. Jean-Baptiste, “Clinical assessment and management of massive hemoptysis,” Critical Care Medicine, vol. 28, no. 5, pp. 1642–1647, 2000. View at: Publisher Site | Google Scholar Reference #3: Lafita V, Borge MA, Demos TC. Pulmonary artery pseudoaneurysm: etiology, presentation, diagnosis, and treatment. Semin Intervent Radiol. 2007;24(1):119-123. DISCLOSURES: No relevant relationships by Sharath Bellary, source=Web Response No relevant relationships by Sudipa Chowdhury, source=Web Response No relevant relationships by William Meng, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by SUMITANAND MISHRA, source=Web Response No relevant relationships by Rutwik Patel, source=Web Response No relevant relationships by Hari Sharma, source=Web Response