Pulmonary Artery Aneurysms and Pseudoaneurysms in Adults: Findings at CT and Radiography
Elsie T. Nguyen1,
C. Isabela S. Silva1,
Jean M. Seely2,
Semin Chong3,
Kyung Soo Lee3 and
Nestor L. Müller1
1 Department of Radiology, Vancouver General Hospital and The University of
British Columbia, 3350-950 W 10th Ave., Vancouver, BC V5Z 4E3, Canada.
2 Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON
K1Y 4E9, Canada.
3 Department of Radiology, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul 135-710, Korea.
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Fig. 1A —47-year-old woman with congenital polycythemia vera, dyspnea, and
chest discomfort. (Courtesy of Dr. Kun Il Kim, Pusan, Korea) Posteroanterior
chest radiograph shows 9-cm round mass with peripheral calcification in left
upper hemithorax.
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Fig. 1B —47-year-old woman with congenital polycythemia vera, dyspnea, and
chest discomfort. (Courtesy of Dr. Kun Il Kim, Pusan, Korea) Contrast-enhanced
CT scan at 5-mm collimation shows marked enlargement of left pulmonary artery
corresponding to chest radiographic finding.
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Fig. 1C —47-year-old woman with congenital polycythemia vera, dyspnea, and
chest discomfort. (Courtesy of Dr. Kun Il Kim, Pusan, Korea) Contrast-enhanced
CT scan at 5-mm collimation shows markedly enlarged main and left pulmonary
arteries with extensive peripheral calcification. Mechanism of aneurysm
formation in this patient was unknown. It is likely that chronic pulmonary
arterial hypertension secondary to polycythemia contributed to formation of
large aneurysm.
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Fig. 2A —42-year-old woman with shortness of breath and left pulmonary artery
aneurysm due to aplasia of right pulmonary artery. Contrast-enhanced CT scan
shows aneurysm of main pulmonary artery and enlargement of left pulmonary
artery. Evident are prominent bronchial artery (curved arrow), right
internal mammary artery collateral vessels (straight arrow), and
aplasia of right pulmonary artery.
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Fig. 2B —42-year-old woman with shortness of breath and left pulmonary artery
aneurysm due to aplasia of right pulmonary artery. Contrast-enhanced CT scan
shows enlargement of left lower lobe segmental arteries and marked reduction
in size and number of right lower lobe pulmonary vessels. Also evident are
marked right atrial and right ventricular enlargement and right ventricular
hypertrophy with bowing of interventricular septum toward left ventricle,
indicating right-heart strain from pulmonary arterial hypertension.
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Fig. 3A —45-year-old man with patent ductus arteriosus. (Courtesy of Dr. Yeon
Hyeon Choe, Seoul, Korea) Posteroanterior chest radiograph shows curvilinear
calcification in region of left hilum (arrow), cardiomegaly, and
pulmonary vascular redistribution to upper lobes.
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Fig. 3B —45-year-old man with patent ductus arteriosus. (Courtesy of Dr. Yeon
Hyeon Choe, Seoul, Korea) Contrast-enhanced CT scan at level of aortopulmonary
window shows patent ductus arteriosus (arrow).
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Fig. 3C —45-year-old man with patent ductus arteriosus. (Courtesy of Dr. Yeon
Hyeon Choe, Seoul, Korea) Contrast-enhanced CT scan at level of main pulmonary
artery shows narrow base (arrow) of aneurysm of main pulmonary
artery.
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Fig. 3D —45-year-old man with patent ductus arteriosus. (Courtesy of Dr. Yeon
Hyeon Choe, Seoul, Korea) Coronal reconstruction shows patent ductus
arteriosus (white straight arrow) and pulmonary artery aneurysm
(curved arrow). Calcification is absent at communication (black
arrow) of aneurysmal sac and main pulmonary artery (MPA).
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Fig. 4A —57-year-old woman with pulmonary arterial hypertension due to
chronic pulmonary embolism. Cardiac catheterization yielded pulmonary artery
pressures of 66/26 mm Hg with mean pressure of 44 mm Hg. Unenhanced CT scan
shows enlargement of pulmonary arteries and calcified mural thrombus in left
pulmonary artery.
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Fig. 4B —57-year-old woman with pulmonary arterial hypertension due to
chronic pulmonary embolism. Cardiac catheterization yielded pulmonary artery
pressures of 66/26 mm Hg with mean pressure of 44 mm Hg. Contrast-enhanced CT
scan at same level as A shows enlarged bronchial arteries
(arrow).
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Fig. 4C —57-year-old woman with pulmonary arterial hypertension due to
chronic pulmonary embolism. Cardiac catheterization yielded pulmonary artery
pressures of 66/26 mm Hg with mean pressure of 44 mm Hg. High-resolution CT
image shows mosaic perfusion in upper lobes with enlargement of segmental
arteries in areas of increased attenuation.
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Fig. 5A —53-year-old woman with mixed connective tissue disease and shortness
of breath. Posteroanterior chest radiograph shows aneurysmal dilatation of
main (arrow), right, and left pulmonary arteries.
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Fig. 5B —53-year-old woman with mixed connective tissue disease and shortness
of breath. Lateral chest radiograph shows enlargement of central pulmonary
arteries and right ventricular outflow tract. Curvilinear calcification of
right pulmonary artery (arrow) is consistent with long-standing
pulmonary arterial hypertension. Patient had no evidence of interstitial lung
disease or pulmonary embolism. Echocardiography showed presence of pulmonary
arterial hypertension, which was clinically diagnosed as secondary to
plexogenic arteriopathy associated with mixed connective tissue disease.
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Fig. 7 —33-year-old man with hemoptysis and history of tuberculosis. Coronal
reconstruction of contrast-enhanced CT shows focal enhancement
(arrow) corresponding to Rasmussen aneurysm in posterior segment of
left upper lobe.
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Fig. 8A —62-year-old woman with fever and cough due to community-acquired
pneumonia. Unenhanced CT scan shows focus of increased attenuation within
right middle lobe consolidation corresponding to thrombus or hemorrhage within
mycotic segmental artery pseudoaneurysm (arrow).
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Fig. 8B —62-year-old woman with fever and cough due to community-acquired
pneumonia. Contrast-enhanced CT scan at same level as A shows focus of
enhancement corresponding to pseudoaneurysm (arrow).
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Fig. 9A —70-year-old woman with angiosarcoma metastatic to lungs.
Contrast-enhanced axial (A) and coronal oblique (B) CT scans
show multiple pulmonary metastatic lesions and right lower lobe segmental
pulmonary artery pseudoaneurysm.
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Fig. 9B —70-year-old woman with angiosarcoma metastatic to lungs.
Contrast-enhanced axial (A) and coronal oblique (B) CT scans
show multiple pulmonary metastatic lesions and right lower lobe segmental
pulmonary artery pseudoaneurysm.
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Fig. 10B —57-year-old woman with pseudoaneurysm induced by Swan-Ganz catheter.
Sagittal oblique maximum-intensity-projection images at mediastinal (B)
and lung (C) windows show origin of pseudoaneurysm
(arrows).
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Fig. 10C —57-year-old woman with pseudoaneurysm induced by Swan-Ganz catheter.
Sagittal oblique maximum-intensity-projection images at mediastinal (B)
and lung (C) windows show origin of pseudoaneurysm
(arrows).
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Fig. 11A —63-year-old man after insertion of right-chest tube for drainage of
empyema. (Courtesy of Dr. Young Tong Kim, Chunan, Korea) Contrast-enhanced CT
scan shows two adjacent pseudoaneurysms (arrows) in right middle lobe
caused by tube thoracostomy.
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Fig. 11B —63-year-old man after insertion of right-chest tube for drainage of
empyema. (Courtesy of Dr. Young Tong Kim, Chunan, Korea) Three-dimensional
shaded surface display shows origin of two pseudoaneurysms and their relation
to each other.
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Fig. 12A —56-year-old woman with hemoptysis after conventional angiography.
(Courtesy of Dr. Catherine Staples, Kelowna, BC, Canada) Contrast-enhanced CT
scan shows pseudoaneurysm in right middle lobe surrounded by pulmonary
hemorrhage.
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Fig. 12B —56-year-old woman with hemoptysis after conventional angiography.
(Courtesy of Dr. Catherine Staples, Kelowna, BC, Canada) Maximum intensity
projection with lung windows at same level as A shows area of
consolidation in right middle lobe corresponding to pulmonary hemorrhage. Less
extensive peripheral consolidation with centrilobular nodularity is evident in
right lower lobe because of presence of aspirated blood.
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Copyright © 2007 by the American Roentgen Ray Society.
