A pulmonary artery false aneurysm after right middle lobectomy: a case report
© Shaaban et al; licensee BioMed Central Ltd. 2007
Received: 18 December 2006
Accepted: 25 August 2007
Published: 25 August 2007
Pulmonary artery false aneurysm is a rare condition, reported to complicate interventional procedures. We report a case of a false aneurysm of the interlobar pulmonary artery following a right middle lobectomy for lung cancer. This is probably the first reported case.
Pulmonary artery false aneurysm is a rare condition, more common in females and with advancing age. It is related to an increase in pulmonary artery pressure  and has been described as a complication of vascular interventional procedures . However, pulmonary artery pseudoaneurysm as a postoperative complication of pulmonary resection is unreported. We report a case of a false aneurysm of the interlobar pulmonary artery following a right middle lobectomy.
At the second thoracotomy, there were dense and vascular adhesions throughout the pleural space, which was completely obliterated. Mobilisation of the lung was extremely difficult. The entire lung was consolidated and solid. The pulmonary veins were exceedingly friable and attempt to encircle them caused the vessels to tear and result in massive bleeding. In order to maintain vascular control, a pneumonectomy was considered the safest option under the circumstances. Postoperatively, the patient recovery was unremarkable and was discharged home on the eighth postoperative day.
Examination of the bronchial margin and the lung parenchyma showed no residual carcinoma.
False aneurysms result from rupture of all three structural layers of the arterial wall, usually due to penetrating or blunt trauma. False aneurysm of the pulmonary artery has been described in cases of Behcet's syndrome, neoplasia, pulmonary aspergillosis, septic emboli and chest trauma [3–7]. It can also be iatrogenic, especially after Swan Ganz catheter insertion and balloon inflation . The aetiology in our case can simply be due to inadvertent trauma to the pulmonary artery in the first surgery. However, careful pathological examination of the excised lung from the second surgery strongly suggests infection as a precipitating factor for the development of the aneurysm in an already weakened, atherosclerotic pulmonary artery branch. Moreover, an increase in pulmonary arterial pressure post lobectomy is well documented , and could have had a role in the aetiology.
The gold standard for diagnosis used to be pulmonary angiography, but this is now largely superseded by non-invasive CT angiography and 3-D reconstruction. Treatment can be surgical through aneurysmectomy and/or lobectomy or radiological through steel or tungsten coil embolization. In our case, however, owing to a grossly consolidated lung and friable pulmonary vessels, pneumonectomy was elected as the safest option.
Reproduction of the CT scans was carried out at Freeman Laboratories Reprographic Services, funded by Newcastle upon Tyne Hospitals NHS Trust, United Kingdom.
Authors received no external funding for the preparation of this paper. There was no external medical writer involved.
Consent was given by the patient for the case report to be published
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