Percutaneous microwave ablation-induced pulmonary artery pseudoaneurysm: a case description and literature analysis.
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ABSTRACT:
SUBMITTER: Peng JZ
PROVIDER: S-EPMC9929383 | biostudies-literature | 2023 Feb
REPOSITORIES: biostudies-literature
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Percutaneous microwave ablation-induced pulmonary artery pseudoaneurysm: a case description and literature analysis.
Peng Jin-Zhao JZ Bie Zhi-Xin ZX Li Xiao-Guang XG
Quantitative imaging in medicine and surgery 20230102 2
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Project description:Pulmonary artery pseudoaneurysm (PAP) is a rare vascular phenomenon with a high mortality rate, as these entities can enlarge, rupture, and lead to asphyxiation. Pulmonary mucormycosis (PM), an underdiagnosed but an increasingly seen entity in the era of chemotherapy and immunosuppression, is a known cause of PAP, and should be suspected in immunosuppressed patients with hemoptysis. We present a case of PAP due to PM in a patient with recently diagnosed diffuse large B-cell lymphoma of the liver who underwent chemotherapy and developed acute cavitary lung disease and hemoptysis. His diagnosis was delayed due to the withholding of iodinated contrast with computer tomography (CT) imaging in the setting of renal failure. He then underwent embolization of his PAP with resolution of his hemoptysis. PAP is an uncommon cause of hemoptysis that can be diagnosed with CT pulmonary angiography, and mucormycosis is a known but rare cause of PAP in patients with malignancy receiving immunosuppression.
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Project description:Literature on COVID-19-associated pulmonary mucormycosis (CAPM) is sparse. Pulmonary artery pseudoaneurysm (PAP) is an uncommon complication of pulmonary mucormycosis (PM), and rarely reported in CAPM. Herein, we report five cases of CAPM with PAP managed at our center and perform a systematic review of the literature. We diagnosed PM in those with clinico-radiological suspicion and confirmed it by microbiology or histopathology. We encountered five cases of CAPM with PAP (size ranged from 1 × 0.8 cm to ~ 4.9 × 4.8 cm). All subjects had diabetes and were aged 55-62 years (75% men). In two cases, COVID-19 and mucormycosis were diagnosed simultaneously, while in three others, COVID-19 preceded PM. One subject who underwent surgery survived, while all others died (80% mortality). From our systematic review, we identified one additional case of CAPM with PAP in a transplant recipient. CAPM with PAP is rare with high mortality. Early diagnosis and multimodality management are imperative to improve outcomes.
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Project description:BackgroundCardioMEMS heart failure (HF) system is an implantable wireless pressure sensor that is placed in a branch of the pulmonary artery (PA) for remote monitoring of PA pressures in patients with HF. Pulmonary artery injury/haemoptysis can occur during the sensor placement.Case summaryAn 80-year-old male patient with HF with reduced ejection fraction (20%) underwent CardioMEMS HF system implantation for recurrent shortness of breath. He developed haemoptysis and dyspnoea during the procedure, which was managed with furosemide. The patient's computerized tomographic angiography showed a 3.4 cm pseudoaneurysm with active extravasation from the superior segmental branch of the left PA due to injury during device placement. The decision to embolize the pseudoaneurysm was made after a multi-disciplinary team meeting and discussion with the patient. The embolization procedure was carried out successfully with the final left pulmonary angiogram showed complete stasis and no further filling of the pseudoaneurysm sac.DiscussionThe incidence of mortality in patients with PA injury from CardioMEMS devices is high, and therefore prompt diagnosis and management are critical. Pulmonary artery pseudoaneurysms are uncommon and present with haemoptysis. Transcatheter embolization has been shown to be a practical, effective, and safe therapeutic option in stable patients.
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Project description:ObjectiveTo demonstrate the feasibility of percutaneous microwave ablation in desmoid fibromatosis with respect to tumor volume control and improvement in the quality of life.Materials and methodsTwelve microwave ablations were performed in 9 patients with a histological diagnosis of desmoid fibromatosis between January 2010 and January 2019. The study population included 6 female and 3 male, with an age range of 21-76 years (mean = 46.6 years; standard deviation [SD] = 19.3 years). The mean major axis of the tumors was 10.9 cm (SD = 5.2 cm) and mean lesion volume was 212.7 cm³ (SD = 213 cm³). Their anatomical distribution was as follows: 3 lesions in the thigh, 2 in the gluteus, 2 in the leg and 2 in the periscapular region. We evaluated the reduction in tumor volume and improvement in the quality of life based on the Eastern Cooperative Oncology Group (ECOG) scale.ResultsAn average tumor volume reduction of 70.4% (SD = 24.9) was achieved, while the quality of life (ECOG scale) improved in 88.9% of patients.ConclusionPercutaneous microwave ablation may potentially be a safe, effective, and promising technique for controlling tumor volume and improving the quality of life in patients with desmoid fibromatosis.
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Project description:Pulmonary artery pseudoaneurysm is a very rare complication of penetrating thoracic trauma. We present a case of a 27-year-old woman who developed a 6.5-cm traumatic pulmonary artery pseudoaneurysm after suffering multiple stab wounds to the chest and the abdomen. The pseudoaneurysm was successfully treated endovascularly with vascular plug occlusion and coil embolization.
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Project description:BackgroundCoronary artery pseudoaneurysms (PSAs) are uncommon and have poorly understood natural history. Unlike true aneurysms, PSAs do not have all the three layers of the vessel in the aneurysmal wall. The PSAs are most commonly seen after an overzealous percutaneous coronary intervention (PCI) which causes damage to the vessel wall. They usually develop slowly after PCI and PSAs within a month of a PCI are not so common. The PSA may be asymptomatic or present with recurrent angina.Case summaryHere, we report a case of symptomatic PSA to right coronary artery (RCA). The patient had a myocardial infarction for which a PCI was performed to deploy a drug-eluting stent (DES) in the RCA. The patient had in-stent restenosis (ISR) within a week of PCI for which plain old balloon angioplasty (POBA) was performed. The patient continued to have unstable angina and within a month of POBA was diagnosed as a case of PSA by intravascular ultrasound. A covered stent was deployed which effectively sealed off the PSA and resumed normal blood flow to distal vessel. Patient has been doing well on medication [aspirin 75 mg once daily, atorvastatin 80 mg once daily, and P2Y12 platelet inhibitor (Ticagrelor) 90 mg twice daily].DiscussionThe PSAs usually take 6-9 months to develop. However, PSAs have been reported within 1-2 months of PCI. This case also shows that PSAs can occur within a month of PCI. It is possible that over-aggressive and/or high-pressure dilatation and/or deep engagement during POBA performed to open up the ISR could have damaged the struts of the DES and compressed it against the vascular wall. The resultant vascular wall injury could have been the cause of early PSA formation in this case. Hence, cardiologists should be vigilant enough to suspect PSA, especially in a patient presenting with angina. The case also shows that covered stents are a viable option to treat early presentations of PSA.
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Project description:In the normal lung, the only communications between the systemic and pulmonary arterial systems are the connections between the bronchial and pulmonary arteries that occur at the respiratory bronchioles, where pulmonary and bronchial capillaries freely anastomose. Rarely, anomalous connections can occur between normal or aberrant systemic arteries and pulmonary vessels. We performed a comprehensive literature review of all available manuscripts on PubMed and Google Scholar that included a case report or case series with diagnosis of systemic artery to pulmonary venous fistulas who underwent percutaneous treatment. Furthermore, we report three cases of children diagnosed and treated in our Pediatric Cardiology Center.
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Project description:A 70-year-old man was referred to our hospital with a diagnosis of progressive increase in extravasation leading to an iatrogenic coronary artery (CA) pseudoaneurysm within a month of percutaneous coronary intervention (PCI). The pseudoaneurysm was located on the carina side of the proximal left descending artery (LAD) accompanied by peri-stent contrast staining around the left main trunk (LMT). After a shared decision-making process, a second PCI was performed to prevent CA pseudoaneurysm rupture owing to concerns of adhesion around the LMT and difficulty in approaching the carina side of the proximal LAD for surgery. Coil embolization with four coils was performed and kissing stents with two covered stents were implanted. After the "Double-D molding technique," intravascular ultrasound imaging revealed only small residual spaces out of the stents. Final coronary angiography (CAG) revealed no contrast staining of the pseudoaneurysm. Four months after the PCI, follow-up CAG revealed no further pseudoaneurysm enlargement. To the best of our knowledge, this is the first case of PCI for a CA pseudoaneurysm at the LMT bifurcation treated using kissing stents with two covered stents.Learning objectiveCoil embolization and implantation of kissing stents with two covered stents with the "Double-D molding technique" is an optional method to stop further enlargement of the pseudoaneurysm at the left main trunk bifurcation.
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