E2163. Pulmonary Artery Pseudoaneurysms: Dissecting Etiologies and Endovascular Treatment Options
Authors
John Bradley;
University of Kentucky
Cameron Diehl;
University of Kentucky
Graham Meek;
University of Kentucky
McKenzie Bentley;
University of Kentucky
Sophie Humphrey;
University of Kentucky
Ronak Patel;
University of Kentucky
Merve Ozen;
University of Kentucky
Background
Pulmonary artery pseudoaneurysms (PAP) are life-threatening conditions that require emergent intervention. Multiple etiologies can cause PAP, and treatment should be done according to clinical manifestation, etiology, and imaging findings. Our purpose is to review PAP classification and common etiologic conditions associated with PAPs and symptomology suspicious for PAP, warranting radiographic surveillance, to discuss characteristic CT and pulmonary angiographic findings in example cases with relevant history and clinical presentation and approaches to endovascular treatment of life-threatening hemoptysis associated with PAPs.
Educational Goals / Teaching Points
To describe the PAP classification and present cases from various etiologies, review characteristic imaging features of PAP in settings of various etiologies, and to present images depicting successful resolution of PAPs and related massive hemoptysis by means of endovascular intervention, including coil, liquid embolization, and stent placement.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
PAPs are rare manifestations of multiple etiologies, including infection, trauma, neoplasms, and iatrogenic procedures such as pulmonary artery/right heart catheterization, biopsy, and chest tube placement, with a high rate of mortality, particularly when unrecognized or untreated. The most common presentation is massive hemoptysis or incidental pseudoaneurysm on CTA. The treatment is performed according to CTA and conventional pulmonary angiography findings.
Conclusion
PAP is requires immediate intervention due to its life-threatening nature. The underlying etiologies include a range of factors, including infections, traumas, neoplasms, and iatrogenic procedures. CTA stands as the established gold standard for diagnosing PAP and plays a pivotal role in facilitating the precise planning of endovascular or surgical interventions aimed at preventing rupture. In this presentation, we review the most common etiologies and endovascular treatment options.
