A Conservative Approach to a Large Mycotic Pulmonary Pseudoaneurysm

Pulmonary mycotic pseudoaneurysm is a rare complication of bacteremia with high associated mortality. We present a case of a large proximal pulmonary artery pseudoaneurysm as a result of methicillin-sensitive Staphylococcus aureus bacteremia, originating from a tunneled dialysis catheter infection. This case was ultimately managed conservatively with surveillance imaging and a prolonged intravenous antibiotic course, rather than with surgical or interventional management. To our knowledge, this is the first reported case of a mycotic pulmonary pseudoaneurysm due to septic embolization of an infected superior vena cava thrombus.

Operative intervention for a central pulmonary artery pseudoaneurysm

Pulmonary artery pseudoaneurysms are a rare but potentially lethal diagnosis. They can be further categorized by etiology or location and are typically successfully treated with endovascular therapies. However, they occasionally require operative intervention. Here, we present a case of a patient who presented with a central pulmonary artery pseudoaneurysm on CT scan with unclear etiology that was initially treated with conservative management. However, this was noted to have rapid enlargement on interval imaging necessitating urgent surgical intervention. The patient underwent a median sternotomy, anterior pulmonary artery arteriotomy for exposure, exclusion of the posterior artery pseudoaneurysm with a bovine pericardial patch, and closure of the anterior arteriotomy with a bovine pericardial patch. The patient did well and was discharged on postoperative day eleven with repeat imaging showing resolution.

Late presentation of pulmonary artery pseudoaneurysm following bronchovascular sleeve resection of lung

A 43-year-old man with a history of double sleeve right upper lobectomy for pulmonary sarcoma, presented with worsening haemoptysis. Bronchoscopic and positron emission tomography (PET)CT appearances were suspicious for disease recurrence; however, on attending for CT-guided biopsy, he was found to have a large pseudoaneurysm of his right pulmonary artery. The patient underwent placement of endovascular covered stent with fluoroscopic confirmation of pseudoaneurysm occlusion, and was discharged home on lifelong antiplatelet therapy. To our knowledge, this is the first reported case of pulmonary artery pseudoaneurysm following double (bronchovascular) sleeve resection of the lung, successfully treated by endovascular stenting.