Recurrent pulmonary emboli with aneurysms: think vasculitis and Hughes Stovin syndrome

Over the next 2 years, the patient's shortness of breath on exertion became progressively worse; repeated CT scans of his pulmonary arteries showed progressive dilation with repeated formation of non-occlusive thrombi, despite anticoagulation initially with apixaban and then warfarin. 18Fluorod...

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Published inThe Lancet (British edition) Vol. 402; no. 10411; p. e12
Main Authors Cook, Victoria, Wong, Kirby, Yan, Tristan D
Format Journal Article
LanguageEnglish
Published London Elsevier Limited 21.10.2023
Subjects
Aneurysm
Aneurysms
Anticoagulants
Aorta
Aortic arch
Arteries
Carotid arteries
Carotid artery
Computed tomography
Dyspnea
Medical imaging
Metabolism
Positron emission
Positron emission tomography
Pulmonary arteries
Pulmonary artery
Vasculitis
Vein & artery diseases
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Summary:Over the next 2 years, the patient's shortness of breath on exertion became progressively worse; repeated CT scans of his pulmonary arteries showed progressive dilation with repeated formation of non-occlusive thrombi, despite anticoagulation initially with apixaban and then warfarin. 18Fluorodeoxyglucose (18F-FDG) PET/CT scan showed increased metabolism in the patient's pulmonary arteries, carotid arteries, and the aortic arch. On examination in our clinic, we found the patient to be well; he showed no signs of respiratory distress at rest but had reduced breath sounds throughout both lungs. A review of recent CT images showed that the aneurysms had continued to enlarge: the main pulmonary artery aneurysm was 49 mm, the left interlobar pulmonary artery aneurysm was 50 mm, and the right interlobar pulmonary artery aneurysm was 41 mm (figure; appendix).
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content type line 23
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(23)01776-2