Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2015;68:1175 - Vol. 68 Num.12 DOI: 10.1016/j.rec.2015.02.016

Pulmonary Nodules as Presentation of Pulmonary Artery Aneurysm

Pedro Martínez-Losas a,, José Luis Rodrigo a, Leopoldo Pérez de Isla a

a Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain

Article

Idiopathic pulmonary artery aneurysms are a rare and difficult to diagnose vascular entity. Because symptoms are nonspecific or absent, they are sometimes diagnosed as a chance finding on imaging.

We report the case of a 63-year-old female smoker, with no cardiovascular symptoms, who underwent an outpatient study following detection of multiple mediastinal and pulmonary nodules in a preoperative chest radiograph (Figure 1).

Figure 1.

As part of the study, we requested positron emission tomography/computed tomography, which revealed that the lesions described on radiography corresponded to marked dilatation of the pulmonary artery, up to 57 mm in the main trunk, affecting both main branches (Figure 2), with an aneurysmal focus in the right upper lobe, with a 26-mm diameter (Figure 2).

Figure 2.

We extended the study to transthoracic echocardiography, which showed no pulmonary hypertension, valve disease, or left ventricular dysfunction; we administered multiple injection s of agitated saline serum, but observed no intracardiac or extracardiac shunt. We also ruled out traumatic, inflammatory, and infectious causes.

The treatment of pulmonary artery aneurysms is controversial. In this case, since the patient was asymptomatic, and considering the idiopathic etiology, with aneurysm size < 60 mm without right ventricular dysfunction or associated shunt, we opted for conservative management with close monitoring.

Corresponding author: martinezlosas@gmail.com

1885-5857/© 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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