[Clinical characteristics and CT angiography manifestations of central pulmonary artery pseudoaneurysm]
- PMID: 40300868
- DOI: 10.3760/cma.j.cn112147-20241118-00680
[Clinical characteristics and CT angiography manifestations of central pulmonary artery pseudoaneurysm]
Abstract
Objective: To investigate the clinical characteristics and pulmonary artery CT angiography (CTA) manifestations of central pulmonary artery pseudoaneurysms (PAPA), aiming to improve diagnostic accuracy. Methods: Twenty-three patients with complete clinical data of hemoptysis due to central PAPA admitted to Liangzhou Hospital of Wuwei City and the First Hospital of Lanzhou University from April 2019 to August 2024 were retrospectively included. There were 10 males and 13 females, with a mean age of 68 years (49-78 years). The patients were analyzed for underlying disease, CTA manifestations of the pulmonary artery of PAPA, single maximum hemoptysis and outcomes. Results: Pulmonary tuberculosis was identified as the primary etiology in 95.7% (22/23) of cases. PAPAs were located in the left inferior pulmonary artery (PA) trunk (9 cases), right inferior PA trunk (6 cases), left lower lobe basal segment PA trunk (2 cases), right lower lobe basal segment PA trunk (4 cases), left upper lobe PA trunk (1 case), and left lingular segment PA trunk (1 case). All PAPAs were solitary lesions with morphological variations: finger-like (9 cases, 39.1%, 9/23), sac-like (6 cases, 26.1%, 6/23), nodular (4 cases, 17.4%, 4/23), beak-like (2 cases, 8.7%, 2/23), and umbrella-like (2 cases, 8.7%, 2/23). Adjacent lung tissues exhibited patchy opacities, nodules, flocculent shadows, or consolidation, with 56.5% (13/23) of PAPAs originating from cavitary walls. The mean maximum single-episode hemoptysis volume was 570 ml (range: 150-2000 ml). Thirteen patients without endovascular treatment survived for a mean of 68.5 days, whereas 10 patients with endovascular intervention survived for 709.4 days on average. Thirteen patients died of asphyxia due to massive hemoptysis and 3 died of non-hemoptysis-related causes. Conclusions: Pulmonary tuberculosis is the most common cause of central PAPAs, especially in patients with hilar-adjacent cavities. After rupture of central pulmonary artery pseudoaneurysms (PAPAs), patients experience significantly larger single-episode hemoptysis volumes, leading to high risk of asphyxia-related death. Early pulmonary artery endovascular treatment can improve prognosis and prolong survival time. Pseudoaneurysms are easily missed on axial CT images when: (1) the lesion and its parent artery are not in the same imaging plane, or (2) the lesion has a nodular or beak-like morphology.
目的： 探讨中央型肺动脉假性动脉瘤（PAPA）临床特点及肺动脉CT血管造影（CTA）表现，提高中央型PAPA检出率。 方法： 回顾性纳入武威市凉州医院和兰州大学第一医院2019年4月至2024年8月收治的23例临床资料完整的中央型PAPA所致咯血患者，其中男10例，女13例，平均年龄68岁（49~78岁）。分析患者基础疾病、PAPA肺动脉CTA表现、单次最大咯血量及转归。 结果： 23例PAPA患者中22例患有肺结核（95.7%，22/23）。其中位于左下肺动脉（PA）主干9例、右下PA主干6例、左肺下叶基底段PA干2例、右肺下叶基底段PA干4例、左肺上叶PA干1例、左肺舌段PA干1例。PAPA数量均为单发。形状为指状9例（39.1%，9/23）、囊袋状6例（26.1%，6/23）、结节状4例（17.4%，4/23）、鸟嘴状2例（8.7%，2/23）、伞状2例（8.7%，2/23）。PAPA临近肺组织均表现为不同程度斑片、结节、絮状及大片实变，个别病例有多发空洞，PAPA在空洞壁13例（56.5%，13/23）。患者单次最大咯血量平均约570 ml（150~2 000 ml）。未行肺动脉血管腔内治疗13例，平均生存时间68.5 d。经肺动脉血管腔内介入治疗10例，平均生存时间709.4 d。有13例患者因大咯血窒息死亡，3例患者非咯血原因死亡。 结论： 肺结核是导致中央型PAPA最常见的原因，且好发于肺门附近伴有空洞的患者。中央型PAPA破裂后患者单次咯血量较大，导致患者窒息死亡风险高，尽早行肺动脉血管腔内治疗可改善患者预后，延长生存时间。在CT轴位图像中瘤体与载瘤动脉不在同一层面时、瘤体形状为结节状和鸟嘴状时容易被漏诊。.