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Aneurysm of the pulmonary artery
 
Published on 2015-04-29 by Elie Chammas
 
 
History and Findings
 

 

A 47 years old female, known to have primary pulmonary hypertension with a full work up done at Cleveland Clinic USA 5 years ago. She is treated since by Bonsentan and sildenafil with an excellent response to the treatment.

 

An echocardiogram done last month revealed normal LV dimensions and function, moderately dilated right cavities with a significant improvement in the right-sided hemodynamics in comparison with prevous studies.  Signigicant aneurysmal dilatation of the main pulmonary artery was noted (5,3 cm). See accompanying videos and image.

 
 
 
video 1 PLAX with pulmonic valve showing | video 2 Modified LAX of pulmonary trunk | video 3 modified SAX view | video 4
 
 
 
 
 
Discussion
 

 

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. 

 

 

References:

 

1. De Tomas Labat ME, Beltran Beltran S, Molina Naveros S, Navarro Botella F,

Alvarez Soto D, Perez Moro E, Aldamiz-Echevarria Castillo G. Idiopathic

pulmonary artery aneurysm: report of a case and review of the literature.

An Med Interna 2005;22(7):329—31.

2. Imazio M, Cecchi E, Giammaria M, Pomari F, Tabasso MD, Ghisio A, Forsennati

PG, Beqaraj F, Favro E, Trinchero R, Brusca A. Main pulmonary

artery aneurysm: a case report and review of the literature. Ital Heart J

2004;5(3):232—7.

3. Deb SJ, Zehr KJ, Shields RC. Idiopathic pulmonary artery aneurysm. Ann

Thorac Surg 2005;80(4):1500—2.

4. Smalcelj A, Brida V, Samarzija M, Matana A, Margetic E, Drinkovic N. Giant,

dissecting, high-pressure pulmonary artery aneurysm: case report of a 1-

year natural course. Tex Heart Inst J 2005;32(4):589—94.

5. Veldtman GR, Dearani JA, Warnes CA. Low pressure giant pulmonary artery

aneurysms in the adult: natural history and management strategies. Heart

2003;89(9):1067—70.

6. Surgical treatment of a pulmonary artery aneurysm

N Vistarini, S Aubert *, I Gandjbakhch, A Pavie. European Journal of Cardio-thoracic Surgery 31 (2007) 1139—1141

 

 

 

 
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jianbin0727 reply on 2017-07-27
 
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