Kumar R, Wales CJ and Fisher M
Department of Diabetology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
Correspondence to; CJ Wales, Dept of Diabetology, Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 OSF.
E-mail welshy@doctors.org.uk
SMJ 2006 51(2): 54
A
64 year old male, chronic smoker, was admitted with weight loss. His chest X-ray
revealed a well-defined opacity in the right lower lobe (Fig
1). A contrast CT of thorax revealed dilated right heart and grossly
enlarged pulmonary arteries with thick walls, especially the right one. No hilar
mass or mediastinal lymphadenopathy was evident (Fig
2 and 3). Chest X-ray mass was presumed to be secondary to enlarged
pulmonary artery. An ECHO failed to show any septal defects or intracardiac
shunt.
Pulmonary
artery aneurysm is a rare cause of nodular lesions (ranging from 2 to 8 cm)
within the lung fields. These
aneurysms usually have no hemodynamic effects. They do not cause arteriovenous
shunting, and the patient does not present with cyanosis. The diagnosis may be
confirmed by CT, MRI or angiography.
Aneurysms
of main or lobar branches of pulmonary artery are very rare. They may be
congenital (associated with other anomalies of heart and great vessels),
post-traumatic (e.g. chest trauma, vessel wall trauma due to an intravascular
catheter), secondary to infection (e.g. staphylococcus, streptococcus,
tuberculosis, syphilis), intracardiac shunts, vasculitis (e.g. Behcet disease)
or idiopathic.
Patients
are mostly asymptomatic or may present with underlying cardiopulmonary disease.
Rarely the aneurysm, if it projects into the bronchial lumen, may lead to
massive haemoptysis.
References
Chung
CW, Doherty JU, Kotler R, et al. Pulmonary artery aneurysm presenting as a
lung mass. Chest 1995; 108:1164
Bartter T, Irwin RS, Nasg G. Aneurysm of the pulmonary arteries. Chest 1988; 94:1065