Management of Pulmonary Artery Aneurysms in Pulmonary Hypertension: A Single-Center Review of 3 Cases

Abstract

Pulmonary artery aneurysms (PAAs) are defined as having pulmonary artery diameter of greater than 40 mm. PAAs are rare and can occur in various pulmonary diseases. There are no clear-cut guidelines regarding the management of PAAs, and recommendations for management are made based on expert consensus opinion, case reports, and institutional experience. This series highlights three patients with pulmonary hypertension (PH) and PAA. The clinical course and diagnostic findings and the decision-making involved in the treatment are reviewed. An overview of three distinct management strategies including medical management, heart/lung transplant, and surgical aneurysm repair is presented.

Figure 1

(a) Noncontrast chest CT showing main pulmonary artery aneurysm measuring 70 mm with blue arrow pointing the possible intimal flap. Rapid tapering of pulmonary vessels can be appreciated on the right lung zones. (b) Transthoracic echocardiogram apical four-chamber view showing severely dilated right ventricle and septal flattening (white arrow). (c) Transthoracic echocardiogram parasternal short axis view at the level of aortic valve showing severe dilation of pulmonary artery.

Figure 2

(a) Transthoracic echocardiogram parasternal short axis color Doppler showing severe pulmonic regurgitation (white arrow) and dilated pulmonary artery. (b) Cardiac MRI showing marked aneurysmal enlargement of the main PA.

Figure 3

(a) CTA chest showing right pulmonary artery aneurysm measuring 80 mm in the greatest dimension with laminated thrombus in the aneurysmal sac (red arrow). (b) Transthoracic echocardiogram apical four-chamber view showing dilated RV, severe TR (white arrow), and systolic septal flattening consistent with RV pressure overload. (c) Extremely elevated estimated PA systolic pressure measurements to 134 mmHg indicating severe PH.