The Role of Pulmonary CT Angiography and Selective Pulmonary Angiography in Endovascular Management of Pulmonary Artery Pseudoaneurysms Associated with Infectious Lung Diseases
- Author(s)
- Tae-Beom Shin; Seong-Kuk Yoon; Ki-Nam Lee; Jin-Su Choi; Young-Hwan Kim; Chang-Gyu Sung; Yong-Joo Kim; Chang-Won Kim
- Keimyung Author(s)
- Choi, Jin Soo; Kim, Young Hwan
- Department
- Dept. of Radiology (영상의학)
- Journal Title
- Journal of Vascular and Interventional Radiology
- Issued Date
- 2007
- Volume
- 18
- Issue
- 7
- Keyword
- PAP; pulmonary artery pseudoaneurysm
- Abstract
- PURPOSE: To determine the value of performing selective angiography based on the findings of pulmonary
computed tomographic (CT) angiography for the detection of a pulmonary artery pseudoaneurysm (PAP) associated
with infectious lung diseases and to evaluate the usefulness of endovascular management of these PAPs.
MATERIALS AND METHODS: Over a 6-year period, 11 PAPs were diagnosed in 10 patients (seven men and three
women; age, 23–84 years). All patients presented with massive hemoptysis. The underlying diseases were cavitary
pulmonary tuberculosis (n = 7), lung abscess (n = 2), and a fungus ball (n = 1). The detection rates of PAP by
bronchial/thoracic angiography, main pulmonary angiography, and selective pulmonary angiography were analyzed.
When a pseudoaneurysm was detected, feeding artery occlusion was performed with coils or n-butyl cyanoacrylate.
RESULTS: The findings of main pulmonary angiography were contrast agent filling of the pseudoaneurysm (n = 4)
and hypoperfusion of the diseased pulmonary segment without contrast agent filling of the pseudoaneurysm (n = 6).
The selective angiogram based on pulmonary CT angiography demonstrated five cases of pseudoaneurysm that were
not found on the main pulmonary angiogram. Embolization of the pseudoaneurysm was successfully performed in
nine of the 10 patients. One patient experienced a rupture of the subsegmental branch of the inferior pulmonary artery
during the procedure.
CONCLUSION: Because main pulmonary angiography alone may fail to demonstrate a pseudoaneurysm, a selective
angiogram based on the anatomic information obtained from pulmonary CT angiography is essential for detection of
a pseudoaneurysm. In addition, endovascular management of a PAP appears to be a safe and effective treatment.
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