Infectious Pulmonary Artery Pseudoaneurysm That Resolved with Conservative Treatment

Pulmonary artery pseudoaneurysms (PAPs) are rare but can cause massive hemoptysis if they rupture. Infectious PAPs are often treated by surgery or transcatheter embolization and are rarely treated conservatively with antibiotics. We herein report a case of PAP treated conservatively in a 21-year-old...

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Published inInternal Medicine Vol. 61; no. 20; pp. 3089 - 3093
Main Authors Nakayama, Toshihiro, Suzuki, Manabu, Yamaguchi, Yoh, Iikura, Motoyasu, Izumi, Shinyu, Takeda, Yuichiro, Hojo, Masayuki, Sugiyama, Haruhito
Format Journal Article
LanguageEnglish
Published Tokyo The Japanese Society of Internal Medicine 15.10.2022
Japan Science and Technology Agency
Subjects
Ampicillin
Antibiotics
Case reports
conservative treatment
Embolization
false aneurysm
Hemoptysis
Internal medicine
lung abscess
Pseudoaneurysm
Pulmonary artery
Sulbactam
surgery
therapeutic embolization
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Abstract Pulmonary artery pseudoaneurysms (PAPs) are rare but can cause massive hemoptysis if they rupture. Infectious PAPs are often treated by surgery or transcatheter embolization and are rarely treated conservatively with antibiotics. We herein report a case of PAP treated conservatively in a 21-year-old woman with lung abscess. Except for one massive hemoptysis early in the course, the patient responded well to the empirical therapy with ampicillin/sulbactam and systemic hemostatic agents. After six weeks of antibiotics, the pseudoaneurysm disappeared. Conservative therapy with careful observation can be considered in small infectious PAPs when there is a good clinical response to initial conservative therapy.
AbstractList Pulmonary artery pseudoaneurysms (PAPs) are rare but can cause massive hemoptysis if they rupture. Infectious PAPs are often treated by surgery or transcatheter embolization and are rarely treated conservatively with antibiotics. We herein report a case of PAP treated conservatively in a 21-year-old woman with lung abscess. Except for one massive hemoptysis early in the course, the patient responded well to the empirical therapy with ampicillin/sulbactam and systemic hemostatic agents. After six weeks of antibiotics, the pseudoaneurysm disappeared. Conservative therapy with careful observation can be considered in small infectious PAPs when there is a good clinical response to initial conservative therapy.
Pulmonary artery pseudoaneurysms (PAPs) are rare but can cause massive hemoptysis if they rupture. Infectious PAPs are often treated by surgery or transcatheter embolization and are rarely treated conservatively with antibiotics. We herein report a case of PAP treated conservatively in a 21-year-old woman with lung abscess. Except for one massive hemoptysis early in the course, the patient responded well to the empirical therapy with ampicillin/sulbactam and systemic hemostatic agents. After six weeks of antibiotics, the pseudoaneurysm disappeared. Conservative therapy with careful observation can be considered in small infectious PAPs when there is a good clinical response to initial conservative therapy.Pulmonary artery pseudoaneurysms (PAPs) are rare but can cause massive hemoptysis if they rupture. Infectious PAPs are often treated by surgery or transcatheter embolization and are rarely treated conservatively with antibiotics. We herein report a case of PAP treated conservatively in a 21-year-old woman with lung abscess. Except for one massive hemoptysis early in the course, the patient responded well to the empirical therapy with ampicillin/sulbactam and systemic hemostatic agents. After six weeks of antibiotics, the pseudoaneurysm disappeared. Conservative therapy with careful observation can be considered in small infectious PAPs when there is a good clinical response to initial conservative therapy.
ArticleNumber 9021-21
Author Nakayama, Toshihiro
Yamaguchi, Yoh
Izumi, Shinyu
Iikura, Motoyasu
Hojo, Masayuki
Sugiyama, Haruhito
Takeda, Yuichiro
Suzuki, Manabu
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10.1016/j.ijid.2013.03.013
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10.1016/j.pupt.2016.07.006
10.1016/S0003-4975(10)65686-X
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10.1155/2018/8251967
10.1155/1998/627514
10.1016/S0022-5223(19)32830-2
10.2169/naika.98.2885
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10.1016/j.jvir.2007.04.015
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10.25259/JCIS_134_2020
10.2169/internalmedicine.48.2610
10.1542/peds.2019-0672
10.21037/cdt.2018.04.01
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1. Park HS, Chamarthy MR, Lamus D, Saboo SS, Sutphin PD, Kalva SP. Pulmonary artery aneurysms: diagnosis & endovascular therapy. Cardiovasc Diagn Ther 8: 350-361, 2018.
11. Yetkin NA, Tutar N. Intravascular coil migration to bronchus: review of the literature with two case reports. Tuberk Toraks 67: 307-313, 2019.
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References_xml – reference: 4. Saida T, Ninomiya H, Yamasaki M, Yamauchi T. Mycotic pulmonary artery aneurysm as a late complication of infective endocarditis after pacemaker implantation. Radiat Med 25: 240-242, 2007.
– reference: 11. Yetkin NA, Tutar N. Intravascular coil migration to bronchus: review of the literature with two case reports. Tuberk Toraks 67: 307-313, 2019.
– reference: 17. Generalis S, Gonçalves de Mendonça R, Marchiori E. Spontaneous regression of an infectious pulmonary artery pseudoaneurysm. Arch Bronconeumol S0300-2896(18)30075-9, 2018.
– reference: 5. Chen Y, Gilman MD, Humphrey KL, et al. Pulmonary artery pseudoaneurysms: clinical features and CT findings. Am J Roentgenol 208: 84-91, 2017.
– reference: 16. Walasangikar V, Dey AK, Sharma R, et al. Pulmonary mycotic pseudo-aneurysm with a prior history of ventricular septal defect. Case report with review of literature. Pneumonol Alergol Pol 84: 178-180, 2016.
– reference: 6. Sharma PK, Garisa SS, Kumaran SV, Varma S. Mycotic (infected) pseudoaneurysm, a diagnostic challenge - case series. J Clin Imaging Sci 10: 86, 2020.
– reference: 1. Park HS, Chamarthy MR, Lamus D, Saboo SS, Sutphin PD, Kalva SP. Pulmonary artery aneurysms: diagnosis & endovascular therapy. Cardiovasc Diagn Ther 8: 350-361, 2018.
– reference: 3. McLean L, Sharma S, Maycher B. Mycotic pulmonary arterial aneurysms in an intravenous drug user. Can Respir J 5: 307-311, 1998.
– reference: 21. Kinoshita T, Ohbe H, Matsui H, Fushimi K, Ogura H, Yasunaga H. Effect of tranexamic acid on mortality in patients with haemoptysis: a nationwide study. Crit Care 23: 347, 2019.
– reference: 22. Bellam BL, Dhibar DP, Suri V, et al. Efficacy of tranexamic acid in haemoptysis: a randomized, controlled pilot study. Pulm Pharmacol Ther 40: 80-83, 2016.
– reference: 23. Spiliopoulos K, Magouliotis DE, Spanos K, et al. Facing a dilemma in the treatment of an internal mammary artery mycotic pseudoaneurysm: coil embolization or surgery? A case report and brief literature review. J Surg Case Rep 2020: rjaa271, 2020.
– reference: 12. Symbas PN, Scott HW Jr. Traumatic aneurysm of the pulmonary artery. J Thorac Cardiovasc Surg 45: 645-649, 1963.
– reference: 10. Falagas ME, Nikou SA, Siempos II. Infections related to coils used for embolization of arteries: review of the published evidence. J Vasc Interv Radiol 18: 697-701, 2007.
– reference: 13. Wilson T-N, Tew K, Taranath A. Multiple mycotic aneurysms of the pulmonary arteries resolving with conservative management: multislice CT examination findings. J Thorac Imaging 23: 197-201, 2008.
– reference: 19. Iki Y, Hata A, Fukuyama M, et al. Successful conservative treatment of mycotic pulmonary artery aneurysms caused by MRSA bacteremia. Pediatrics 144: e20190672, 2019.
– reference: 20. Liang C, Bista B. Multiple pulmonary artery mycotic aneurysms and septic emboli in a patient with tricuspid valve vegetation and infective endocarditis. Radiol Case Rep 16: 128-131, 2021.
– reference: 9. Monchik J, Wilkins EW Jr. Solitary aneurysm of the middle lobe artery. A case report and review of solitary peripheral pulmonary artery aneurysms. Ann Thorac Surg 17: 496-503, 1974.
– reference: 15. Haranaga S, Teruya H, Nakamura H, Higa F, Tateyama M, Fujita J. Pulmonary artery pseudoaneurysm secondary to lung abscess. Intern Med 48: 2159-2160, 2009.
– reference: 8. Morinaga Y, Yanagihara K, Gyotoku H, et al. Pulmonary artery pseudoaneurysm caused by Streptococcus constellatus. Int J Infect Dis 17: e1064-6, 2013.
– reference: 2. Koneru H, Biswas Roy S, Islam M, et al. Pulmonary artery pseudoaneurysm: a rare cause of fatal massive hemoptysis. Case Rep Pulmonol 2018: 8251967, 2018.
– reference: 14. Saruki H, Ogata N, Kawasaki T, et al. Type 2 diabetes mellitus with hemoptysis suspiciously caused by infectious pulmonary artery aneurysm associated with pneumonia. Nihon Naika Gakkai Zasshi (J Jpn Soc Intern Med) 98: 2885-2887, 2009 (in Japanese).
– reference: 18. Lazic S, Rhodes A, Van Zeller C, Mahendran S. Self-resolving pulmonary artery pseudoaneurysm. BMJ Case Rep 12: e232527, 2019.
– reference: 7. Sunagawa K, Uchino Y, Ishimoto S, et al. Mycotic pseudoaneurysm of a pulmonary artery branch caused by Cladosporium. Pathol Int 68: 47-52, 2018.
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  doi: 10.5603/PiAP.2016.0021
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  doi: 10.1155/1998/627514
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  doi: 10.2169/naika.98.2885
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  doi: 10.1016/j.radcr.2020.11.006
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  doi: 10.2169/internalmedicine.48.2610
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Snippet Pulmonary artery pseudoaneurysms (PAPs) are rare but can cause massive hemoptysis if they rupture. Infectious PAPs are often treated by surgery or...
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SubjectTerms Ampicillin
Antibiotics
Case reports
conservative treatment
Embolization
false aneurysm
Hemoptysis
Internal medicine
lung abscess
Pseudoaneurysm
Pulmonary artery
Sulbactam
surgery
therapeutic embolization
Title Infectious Pulmonary Artery Pseudoaneurysm That Resolved with Conservative Treatment
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