Intra-aneurysmal glue embolisation of a giant pulmonary artery pseudoaneurysm after left upper lobe lobectomy: case report

Abstract

We report a case of pseudoaneurysm of the anterior ascending branch of the left pulmonary artery, following a left upper lobectomy for pulmonary aspergillosis, for which we have done an endovascular treatment. This is the first case where complete pseudoaneurysm occlusion was accomplished after a transcatheter intra-aneurysmal N-butyl 2-cyanoacrylate (glue) injection.

Keywords: Embolisation; Lobectomy; Pseudoaneurysm; Pulmonary artery.

Fig. 1

30-years lady with pulmonary artery aneurysm. A. Preembolization sagittal multiplanar reconstruction (MPR) CT image of pulmonary angiography shows PAA arising from anterior ascending branch of left pulmonary artery. Note small and wide neck (white arrow) of feeding branch. B. Oblique coronal MPR CT image (lung windows) shows round soft tissue mass (PAP) projecting into left upper chest pneumothorax. C. Pulmonary angiography (lateral view) shows approximately 2.8 cm heart shaped aneurysm from anterior ascending branch. D. Check angiogram, post glue (75%) embolisation, shows residual filling of aneurysm. Irregular band shaped filling defect seen within central part of PAP is due to solidified glue (black arrows). E. Post glue (50%) embolisation angiogram shows complete obliteration of aneurysm. Feeding artery is seen to be patent (long black arrow). Note displaced coils (small black arrows) in lower lobe branches. There is no occlusion to flow of blood in these lower lobe branches. F. Post embolisation, spot film shows glue cast filling entire PAP. Note migrated coil within aneurysm sac (black arrow). Coils in lower lobe branches are also seen. G. Sagittal MPR of CT pulmonary angiography at 2 months interval shows glue cast in aneurysm. There is no filling of aneurysm. Pneumothorax seen previously is partially resolved now. H. Oblique coronal MPR CT image shows lower lobe arteries with coils in their lumen being opacified. New aspergilloma is seen in lateral basal segment of left lobe (black arrow) and rib osteomyelitis (small black arrows).