Pulmonary arterial aneurysm
School ager
with osteomyelitis of the left lower extremity. CXR PA (above left) shows a large, round lesion projecting to the right of the heart while the lateral (above right) shows it to be located posteriorly in the chest. Coronal (below left) and axial (below right) CT with contrast of the chest shows the distal right main pulmonary artery to be aneurysmally dilated.The diagnosis was right pulmonary arterial aneurysm.
Akute
Dissektion der Pulmonalarterie: Abbildung 3: Kontrastmittelverstärkte Computertomographie-Pulmonalisangiographie: axiale dünne «maximum intensity projection» (MIP) mit Darstellung der massiven Dilatation des Truncus pulmonalis und der Pulmonalarterien sowie der Dissektionsmembran.
Massive
hemoptysis and deep venous thrombosis presenting in a woman with Hughes-Stovin syndrome: a case report. Cardiac magnetic resonance imaging showed the aneurysm in the right interlobar pulmonary artery (white arrow).
Newborn with
abnormal prenatal cardiac ultrasound. CXR AP (above) shows an abnormal and prominent contour to the left superior mediastinum. The right superior mediastinum contour represents the thymus. Coronal CT with contrast of the chest (below) shows aneurysmal dilation of the main pulmonary artery. The pulmonary valve was absent.The diagnosis was main pulmonary arterial aneurysm due to absent pulmonary valve syndrome.
Pictorial
review of the pulmonary vasculature: from arteries to veins. Pulmonary artery aneurysm in a patient with Behçet’s disease. a Three-dimensional reconstruction from a contrast-enhanced CT scan showing a right lower lobe pulmonary artery aneurysm in a patient with Behçet’s disease (white arrow). Digital subtraction fluoroscopic images obtained before (b) and after (c) coil embolisation of the right lower lobe pulmonary aneurysm (white arrow)
Akute
Dissektion der Pulmonalarterie: Abbildung 5: Kontrastmittelverstärkte Computertomographie-Pulmonalisangiographie: koronare dünne «maximum intensity projection» (MIP) mit Darstellung der Kompression des kaliberkräftigen mittleren RIVA (Pfeil) durch das Aneurysma und Dissektion des Truncus pulmonalis.
A case of
giant main pulmonary artery aneurysm associated with complicated congenital heart disease and simultaneous chronic pulmonary artery dissection. Computed tomography angiography. a Main pulmonary aneurysmal dilation with a diameter of 14 cm. b Aortic coarctation at the aortic isthmus and a small patent ductus arteriosus at the ductus arteriosus. c CTA showing pulmonary artery dissection
Massive
hemoptysis and deep venous thrombosis presenting in a woman with Hughes-Stovin syndrome: a case report. Chest radiograph revealed an ill-defined rounded infiltrate in the right lower lobe (white arrow).
Massive
hemoptysis and deep venous thrombosis presenting in a woman with Hughes-Stovin syndrome: a case report. Contrast-enhanced computed tomography scans of the chest demonstrated a right lower lobe pulmonary artery aneurysm (white arrow).
A radiologic
review of hoarse voice from anatomic and neurologic perspectives. Pulmonary artery aneurysm. A 78-year-old man with advanced congestive heart failure secondary to congenital pulmonary artery stenosis status post multiple corrective surgeries, now presenting with progressive shortness of breath and speaking difficulty despite adequate management of heart failure. Axial CTA image (a) through the mediastinum reveals aneurysmal dilatation of the left pulmonary artery (white arrows). An axial CTA image through the larynx (b) reveals thickening of the left aryepiglottic fold (white arrowhead) and dilatation of the left piriform sinus (black arrow). A coronal CTA image (c) demonstrates effacement of the aortopulmonary window (black arrows) by the pulmonary artery aneurysm (white arrows) with presumed compression of the left recurrent laryngeal nerve
Insights into
imaging of aortitis. a, b A 23-year-old male with Behçet"s disease. Axial (a), sagittal reformatted (b) contrast-enhanced CT images show partially thrombosed right pulmonary artery aneurysm (arrow)
Pulmonary
arterial aneurysm • Main pulmonary artery aneurysm - Ganzer Fall bei Radiopaedia
Pulmonary
arterial aneurysm • Pulmonary arterial aneurysm - Ganzer Fall bei Radiopaedia
Septic
pulmonary emboli • Septic pulmonary emboli and infective aneurysms - Ganzer Fall bei Radiopaedia
Behçet
disease • Pulmonary artery aneurysms - Behçet disease - Ganzer Fall bei Radiopaedia
Pulmonary
vasculitis • Pulmonary Behçet disease - Ganzer Fall bei Radiopaedia
Hughes-Stovin
Syndrome: a case report and review of the literature. Contrast Enhanced pulmonary MRA (coronal MIP) showing aneurysm of the right lower lobe pulmonary artery.
Hughes-Stovin
Syndrome: a case report and review of the literature. Chest Contrast Enhanced-MSCT angiography axial section showing a partially thrombosed aneurysm of the right lower lobe pulmonary artery, and thrombosed segmental branch of the left lower lobe pulmonary artery.
Insights into
imaging of aortitis. A 31-year-old male with Behçet"s disease. Coronal maximum-intensity projection CT image (a) shows thrombosed left lower lobe pulmonary artery aneurysm (arrow) and pleural-based, wedge-shaped infarction (arrowhead). Axial CT image (b) also shows a thrombosed left lower lobe pulmonary arterial aneurysm (arrow)
Massive
hemoptysis and deep venous thrombosis presenting in a woman with Hughes-Stovin syndrome: a case report. Pulmonary angiography showed a single aneurysm of the right interlobar pulmonary artery (black arrow).
Pulmonary arterial aneurysms refer to a focal dilatation of the pulmonary arterial system.
Epidemiology
Overall it is considered a rare entity with autopsy prevalence rates of around 1 in 14,000 to 100,000 .
Pathology
A true pulmonary artery aneurysm results from dilatation of all three layers of the vessel wall while a pulmonary artery pseudoaneurysm does not involve all layers of the arterial wall. Most of the aneurysms are central, affecting the main pulmonary arteries .
Etiology
The differential for etiologies of pulmonary artery aneurysms can be broad. Different sources differ as to the most frequent etiologies, likely due to the rarity of the entity and reliance on limited case series.
- vascular
- pulmonary arterial hypertension
- pulmonary valvular / post-valvular stenosis and regurgitation
- cystic medial degeneration
- tuberous sclerosis (secondary to vascular dysplasia)
- pulmonary arterial hypertension
- infectious
- mycotic aneurysm (e.g. intravenous drug users)
- tuberculosis: Rasmussen aneurysm
- syphilis
- traumatic (often pseudoaneurysm)
- blunt or penetrating trauma, most commonly extravascular due to stab wound
- iatrogenic, most commonly endovascular due to malpositioned pulmonary artery catheter
- autoimmune
- Behçet disease (most common) and it's variant Hughes-Stovin syndrome
- giant cell arteritis
- idiopathic
- congenital
- congenital left-to-right shunts, most commonly patent ductus arteriosus
Radiographic features
Plain radiograph
Radiographic features are non-specific and they may appear as hilar enlargement or a lung nodule.
CT
CT angiography (CTA) allows a much better appreciation of the anatomy. Some consider enlargement or ectasia of the pulmonary trunk on CT scan to be 29 mm and the right interlobar artery to be 17 mm . Proximal pulmonary artery aneurysms are defined by pulmonary trunk diameter > 4 cm .
Management
Patients with pulmonary hypertension and pulmonary artery aneurysm may be challenging and potentially carry high surgical risk. These patients should be evaluated by an experienced heart and lung transplantation centers. Strategies can be variable depending upon underlying disease, etiology, center dependent expertise, and resources available. Multidisciplinary consensus should be obtained to offer patients individualized treatment options. In patients with severe pulmonary hypertension, the available case reports describe the need for replacement of the entire main pulmonary artery.
See also
- pulmonary arterial ectasia
- bronchial artery aneurysm
- pulmonary artery pseudoaneurysm
- idiopathic dilatation of the pulmonary trunk
Siehe auch:
- Vaskulitis
- Morbus Behçet
- Marfan-Syndrom
- arteriovenöse Malformationen der Lunge
- pulmonale Hypertonie
- pulmonale Vaskulitis
- Hughes-Stovin-Syndrom
- Rasmussen-Aneurysma
- Heiserkeit
- erweiterte Pulmonalarterie
- Dissektion Pulmonalarterien
und weiter:
Assoziationen und Differentialdiagnosen zu Aneurysma der Arteria pulmonalis:
