Percutaneous stent-graft repair of a mycotic pulmonary artery pseudoaneurysm.
Ruptured mycotic pulmonary pseudoaneurysm is a lethal complication. Emergent surgical repair is usually recommended, but still associated with a high mortality rate. We present a patient in whom mycotic pulmonary pseudoaneurysm was a complication after surgical lobectomy 2 weeks earlier. This patient had suffered from repeated massive hemoptysis. After emergent surgical repair of the ruptured pulmonary artery stump, another episode of massive hemorrhage occurred. The pulmonary arteriogram revealed a segmental stenosis and a large, wide-necked, lobulated pseudoaneurysm at the left proximal pulmonary artery. We deployed a balloon-expandable stent-graft (48 mm in length mounted on a 12 mm x 40 mm angioplasty balloon) across the stenotic segment and the neck of the pulmonary pseudoaneurysm. Hemostasis was achieved immediately and, under a 4-week antibiotic treatment, patient was transferred to a local hospital for medical care. This case report demonstrates the benefit of minimally invasive endovascular therapy in a critically ill patient. A literature review of the etiology and management of mycotic pulmonary pseudoaneurysm is included.
Chou
Mei-Chun
MC
Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan.
Liang
Huei-Lung
HL
Pan
Huay-Ban
HB
Yang
Chien-Fang
CF
D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000628:therapy*; D000785:Aneurysm, Infected / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000628:therapy*; D000800:Angioplasty, Balloon; D019917:Blood Vessel Prosthesis Implantation; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011859:Radiography; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy; D020615:Stenotrophomonas maltophilia; D015607:Stents