When the diagnosis is a zebra: pulmonary artery aneurysm.
Some ailments maypresent so distinctively that the diagnosis is often unquestionable. Other cases, however, may present typically, but have atypical findings. We describe a case of a patient who presented to our institution with recurrent hemoptysis. The clinical features were suggestive of an underlying infection or malignancy. When these were ruled out, the search for a zebra had begun. The patient underwent sixty four-slice computerizedtomographic angiography (CTA) which revealed a right pulmonary artery aneurysm (PAA). Timely involvement of interventional radiologists and thoracic surgeons prevented a potentiallylife-threatenninghemorrhage. This case underlines the importance of awareness of this condition in the formulation of a differential diagnosis forhemoptysis. PAAis a rare condition that is either congenital or acquired. Common acquired etiologies include chronic thromboembolic pulmonary hypertension, infections (syphilis and tuberculosis), vasculitis (Behcet's and Hughes-Stovin syndromes), neoplasms (primaryandmetastatic), andtrauma(most often iatrogenic).
Division of Cardiology, New York Methodist Hospital-Weill Medical College of Cornell University, Brooklyn, New York 11215, USA.
Vishnu
V
Singh
Mariya
M
Vaksman
Igor
I
Mamkin
Maura
M
Lipp
Bimalin
B
Lahiri
D000783:Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D000792:Angiography / Q000379:methods; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D035583:Rare Diseases; D012008:Recurrence; D014057:Tomography, X-Ray Computed