Journal of Emergencies, Trauma, and Shock
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LETTERS TO EDITOR  
Year : 2017  |  Volume : 10  |  Issue : 2  |  Page : 87
Successful conservative repair of the traumatic left main pulmonary artery pseudoaneurysm


1 Department of Thoracic Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan
2 Department of Emergency Medicine, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan

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Date of Submission23-Sep-2016
Date of Acceptance07-Oct-2016
Date of Web Publication3-Mar-2017
 

How to cite this article:
Sakai M, Ozawa Y, Kohno M. Successful conservative repair of the traumatic left main pulmonary artery pseudoaneurysm. J Emerg Trauma Shock 2017;10:87

How to cite this URL:
Sakai M, Ozawa Y, Kohno M. Successful conservative repair of the traumatic left main pulmonary artery pseudoaneurysm. J Emerg Trauma Shock [serial online] 2017 [cited 2017 Jul 21];10:87. Available from: http://www.onlinejets.org/text.asp?2017/10/2/87/201582


Dear Editor,

Traumatic pulmonary pseudoaneurysm is a rare but lethal condition. Traditional treatment includes surgery or embolization. Another treatment option is conservative therapy. Only three cases of conservative repair have been reported to date, and two of these patients died.[1] We report a case of successful conservative repair of a blunt traumatic pseudoaneurysm of the main pulmonary artery.

A 48-year-old man was admitted to our hospital for multiple traffic traumas. Computed tomography revealed a left main pulmonary artery pseudoaneurysm 20 mm in diameter and mediastinal hematoma [Figure 1]a. Other injuries were subarachnoid hemorrhage and multiple fractures. We selected conservative therapy for the pseudoaneurysm because the contrast medium did not leak to outside the artery and the follow-up computed tomography of the next day and after 1 week revealed that pseudoaneurysm did not differ in size. After 1 and 2 months later, the pseudoaneurysm regained normal diameter, and mediastinal hematoma was disappeared [Figure 1]b and [Figure 1]c. He was discharged after therapies of other injuries.
Figure 1: A left main pulmonary artery pseudoaneurysm (a) (arrow). 1 month (b) and 2 months after conservative therapy (c), the left main pulmonary artery regained normal diameter and mediastinal hematoma resolved

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Pulmonary pseudoaneurysms are a rare but lethal condition. Common causes include often iatrogenic, infection, neoplasm, trauma, vasculitis, and pulmonary hypertension.[1],[2] Contrast-enhanced computed tomography and angiography are valuable modalities demonstrating the location, size, and rupture. However, the timing of detection was varied from hours to years from the causal event. Traditional therapy was surgery (aneurysmectomy, ligation of vessels, lobectomy, pneumonectomy) or embolization.[1],[2],[3],[4] When it is difficult to encircle the proximal left main pulmonary artery and repair the vascular wall through surgery, pneumonectomy is the viable option. Intraluminal embolization is associated with a high risk of embolus migration to the peripheral lung.

An indication of conservative treatment was still controversial. Previous nonoperative cases presented delayed and fatal massive hemoptysis. Peripheral location, small size, lack of symptom, and reduction in size were acceptable for nonoperative treatment.[1] In our case, although an aneurysm was proximal in origin and not small, conservative treatment was successful. The presence of anatomical structures around the left main pulmonary artery such as the pericardium, mediastinal pleura, and Botallo ligament can reinforce the vascular wall and help avoid pseudoaneurysm rupture.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Reade CC, Jenkins NL, Bard MR, Kuszyk BS, Koutlas TC, Rotondo MF. Immediate diagnosis and nonoperative treatment of a pulmonary artery pseudoaneurysm after blunt traumatic injury. J Trauma 2006;60:894-6.  Back to cited text no. 1
    
2.
Nguyen ET, Silva CI, Seely JM, Chong S, Lee KS, Müller NL. Pulmonary artery aneurysms and pseudoaneurysms in adults: Findings at CT and radiography. AJR Am J Roentgenol 2007;188:W126-34.  Back to cited text no. 2
    
3.
Dimarakis I, Thorpe JA, Papagiannopoulos K. Successful treatment of a posttraumatic pulmonary artery pseudoaneurysm with coil embolization. Ann Thorac Surg 2005;79:2134-6.  Back to cited text no. 3
    
4.
Oz K, Demirhan R, Onan B, Sancakli I. Pulmonary artery pseudoaneurysm after a vascular access port catheter implantation. Ann Thorac Surg 2009;87:295-7.  Back to cited text no. 4
    

Top
Correspondence Address:
Mitsuaki Sakai
Department of Thoracic Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558,
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.201582

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