Pulmonary artery aneurysm (PAA) is a rare anomaly found in ≈1 of every 14 000 autopsies; most of these anomalies are present in the main pulmonary artery. The cause of pulmonary artery aneurysm may be idiopathic; however, other causes include congenital shunt disease, syphilis, atherosclerosis, trauma, and pulmonary hypertension. In >50% of the postmortem cases, pulmonary aneurysms were associated with congenital heart disease, most frequently patent ductus arteriosus. In the remaining reported cases, such aneurysms were associated mainly with secondary acquired lesions, such as syphilis and cystic medial degeneration.
The vast majority of cases of PAA with pulmonary hypertension occurred in the presence of the other cofactors, which may have abetted the process of PAA formation. There are, however, a few cases in which pulmonary hypertension is the only recognizable risk factor as it’s in our case.
It is unclear whether there is a size hinge point similar to aortic aneurysms in which the risk of complication increases. Although some recommend medical treatment for such patients, others recommend surgical intervention for those with an aneurysm that have a diameter of 60 mm or greater. Surgery is indicated to avoid the risk of rupture or dissection (one case of dissecting aneurysm of the pulmonary artery was presented as an abstract during the last Euro Echo meeting in Vienna.
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