Answer for BIR CoW 23 Jan 2022
Pulmonary Pseudoaneurysm
Findings
X-ray: Partially well circumscribed lobular radio-opacity in right lower zone close to the hilum with medial margin in continuation with the descending pulmonary artery. CECT Angio: Irregular lobulated aneurysmal dilatation arising from lower lobar branch of right pulmonary artery with eccentric filling defects – suggestive of partially thrombosed pulmonary pseudoaneurysm.
Discussion
Aneurysm is focal dilatation of a blood vessel that involves all three layers of vessel wall. A pseudoaneurysm does not involve all layers of the arterial wall and is therefore at higher risk of rupture. Focal dilatation of the pulmonary arteries can be congenital or acquired. Common causes include vasculitis, infection, neoplasm, trauma, often iatrogenic and connective tissue disorder. PAPs can be detected on standard chest X-ray as round, well-circumscribed nodules or hilar enlargements. Pulmonary angiography is the gold standard for diagnosing PAPs; however, it is no longer used for diagnostic purposes because it is invasive and provides only a luminal image with little characterization of the surrounding anatomy. Reserved only for endovascular interventions. CT angiography is currently the technique of choice, since it can detect certain PAPs that would not have been identified on a classic angiogram because of their peripheral position, the presence of a flap of vascular tissue acting as a valve, the presence of a thrombus or because of the slow blood flow inside the pseudoaneurysm Urgent endovascular treatment is the preferred approach in managing hemoptysis resulting from PAPAs, and such treatment should not be delayed. Direct coil embolization, endovascular stents, or embolization of the aneurysm’s feeding vessel are the reported effective occlusion modalities
Findings
X-ray: Partially well circumscribed lobular radio-opacity in right lower zone close to the hilum with medial margin in continuation with the descending pulmonary artery. CECT Angio: Irregular lobulated aneurysmal dilatation arising from lower lobar branch of right pulmonary artery with eccentric filling defects – suggestive of partially thrombosed pulmonary pseudoaneurysm.
Discussion
Aneurysm is focal dilatation of a blood vessel that involves all three layers of vessel wall. A pseudoaneurysm does not involve all layers of the arterial wall and is therefore at higher risk of rupture. Focal dilatation of the pulmonary arteries can be congenital or acquired. Common causes include vasculitis, infection, neoplasm, trauma, often iatrogenic and connective tissue disorder. PAPs can be detected on standard chest X-ray as round, well-circumscribed nodules or hilar enlargements. Pulmonary angiography is the gold standard for diagnosing PAPs; however, it is no longer used for diagnostic purposes because it is invasive and provides only a luminal image with little characterization of the surrounding anatomy. Reserved only for endovascular interventions. CT angiography is currently the technique of choice, since it can detect certain PAPs that would not have been identified on a classic angiogram because of their peripheral position, the presence of a flap of vascular tissue acting as a valve, the presence of a thrombus or because of the slow blood flow inside the pseudoaneurysm Urgent endovascular treatment is the preferred approach in managing hemoptysis resulting from PAPAs, and such treatment should not be delayed. Direct coil embolization, endovascular stents, or embolization of the aneurysm’s feeding vessel are the reported effective occlusion modalities
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!