Management Strategies and Outcomes in Pulmonary Artery Pseudoaneurysms
Overview
Pulmonary artery pseudoaneurysms (PAPs) are rare but potentially life-threatening causes of hemoptysis with diverse etiologies including trauma, infection, and COVID-19. This retrospective study of 28 patients highlights the importance of individualized treatment strategies, primarily endovascular embolization, guided by CT angiography and clinical presentation to achieve effective hemostasis.
Background
PAPs occur in 5–11% of patients after embolization of bronchial and systemic collateral arteries and can arise from various causes such as trauma, malignancy, bronchiectasis, and inflammatory lung diseases. The clinical presentation ranges from asymptomatic to massive hemoptysis, which can be fatal if untreated. Multidetector computed tomography (MDCT) is essential for diagnosis and treatment planning. Treatment options include surgery, endovascular embolization, and medical management, with embolization being favored due to lower morbidity.
Data Highlights
A total of 29 PAPs in 28 patients (mean age 59 ± 12.4 years; 25 males) were identified from 5962 thoracic CT angiographies performed between 2010 and 2024. Treatment approaches were selected based on PAP size, location, and vascular anatomy. Pulmonary artery embolization (PAE) was performed when PAPs were visualized on pulmonary arteriography, while bronchial or non-bronchial systemic artery embolization (BAE/SAE) was used when PAPs were not visible on pulmonary arteriography. All patients received systemic hemostatic agents. Endovascular embolization utilized microcoils, N-butyl cyanoacrylate, and polyvinyl alcohol particles depending on the vascular territory.
Key Findings
PAPs have diverse etiologies including trauma, infection, malignancy, and recently COVID-19.
MDCT is critical for detecting PAPs and planning individualized treatment strategies.
Endovascular embolization, including pulmonary artery embolization and bronchial/non-bronchial systemic artery embolization, is effective for hemostasis.
Surgical resection is limited by high morbidity and mortality, especially in massive hemoptysis cases.
Not all PAPs are visualized on pulmonary arteriography; some require systemic artery angiography for detection and embolization.
Systemic hemostatic agents are routinely administered alongside interventional procedures.
Clinical Implications
Clinicians should utilize MDCT angiography for accurate diagnosis and characterization of PAPs to guide treatment. Endovascular embolization tailored to the PAP’s vascular supply offers a minimally invasive and effective approach to control hemoptysis. Awareness that PAPs may not always be visible on pulmonary arteriography underscores the need for comprehensive angiographic evaluation including systemic arteries.
Conclusion
Pulmonary artery pseudoaneurysms require prompt diagnosis and individualized management to prevent life-threatening hemoptysis. Endovascular embolization guided by detailed imaging is a safe and effective treatment modality across diverse PAP etiologies.
References
Various Authors/Multiple Studies/2010-2024 -- Management Strategies for Pulmonary Artery Pseudoaneurysms and Evaluation of Clinical Outcomes
