Informed consent was obtained prior to arterial access and placement of a 5 French sheath in the right GSK1210151A cost common femoral artery. Right upper lobe pulmonary angiography demonstrated
the feeding pulmonary artery (Fig. 3), which was crossed using a Terumo (Terumo Corporation) hydrophilic guide wire and 4 French Bernstein (Cook medical) catheter. A 6 French straight destination sheath was exchanged at the groin and advanced to just beyond the pseudoaneurysm origin. A 6 mm Amplatzer 1 (AGA medical) plug was deployed distally and a second 8 mm Amplatzer 1 plug proximally to occlude both the inflow and any potential for back flow into the pseudoaneurysm. Completion angiography (Fig. 4) demonstrated complete cessation of filling of the pseudoaneurysm. There were no procedural complications. Following embolisation and commencement of antifungal agents there was immediate rapid resolution of haemoptysis and within two days, resolution of pyrexia. A follow up chest x-ray at 8 weeks showed continued satisfactory resolution of the consolidative changes with some right upper lobe volume loss. The Amplatzer plugs were noted to be unchanged in position (Fig. 5). Pulmonary artery pseudoaneurysms (PAP) may result in potentially life threatening haemoptysis but are fortunately
uncommon. In our case, the causative organism resulting in pseudoaneurysm formation is unclear, however severe lobar pneumonia with repeated infection/inflammation and heavy coughing with initially suboptimal antibiotic treatment, Selleckchem SCH772984 may have all played a part. Arterial phase contrast enhanced multislice CT was the key in making the diagnosis and enabled planning of endovascular intervention as well as embolisation device selection. Pseudoaneurysms by definition do not have
a covering of all three layers of the arterial wall and are effectively contained arterial leaks that are considered to be at a high risk of rupture. When occurring within a consolidated or infected lung, the potential for tissue breakdown, at the margins of the pseudoaneurysm and communication Sulfite dehydrogenase with the airways, may result in massive haemoptysis or even death. Early recognition and minimally invasive endovascular treatment may help to reduce the associated mortality rate of PAP. PAP are often associated with trauma and most commonly result secondary to complications from Swan-Ganz catherisation.1 Amongst the infective causes, the most common is due to pulmonary tuberculosis. These pseudoaneurysms, known as Rasmussen aneurysms arise from small to medium sized pulmonary arterial branches in the vicinity of a tuberculous cavity.2 Other cases of PAP have been described with fungal infections, pyogenic bacteria and Mucormycosis.