IJTCVS 2006; 22: 141142 Case reports
Abdoulhossein et al 141 Pulmonary artery aneurysm
Pulmonary artery aneurysm repair with Mersilene Mesh: Report of a case
Davoodabadi Abdoulhossein. MD1, Razi Ebrahim, MD2 1 Department of Thoracic Surgery and 2Department of Internal Medicine, Kashan University of Medical Science, Kashan, Iran
Introduction Pulmonary artery aneurysm is rarely seen in clinical practice, The majority are associated with congenital cardiovascular disease, infection, and trauma.1 Idiopathic pulmonary artery aneurysm is extremely rare and the number of cases had been reported in english literature are limited.2 Although idiopathic pulmonary artery aneurysm is a known disease, repair with Mersilene mesh has not been reported. Case report A 71-year-old male with complaints of exertional dyspnea, cough and left sided chest wall pain was admitted to our hospital in April 1999. He was a non smoker with good general condition. No abnormality was detected in the cardiovascular and respiratory systems. Chest radiograph revealed a large opacity and well-defined mass in the left parahilar region and left upper lobe. (Fig. 1). Computed tomographic (CT) scan suggested left upper lobe mass (Fig. 2). Bronchoscopy was normal, sputum cytology was negative for malignancy and Forced Expiratory Volume (FEV)/1 sec was within lower limit of normal. Due to suspicion of lung malignancy, the patient was scheduled for lobectomy. A huge sacular pulmonary aneurysm, 6 cm in diameter with extension to parenchyma was discovered at the time of thoracotomy. Adhesion to surrounding tissue was moderate and was moderatly thin walled. Mersilene mesh was wrapped around the aneurysm. Post operative recovery was normal.
Address for correspondence: Assistant Professor Davoodabadi Abdoulhossein Department of Thoracic Surgery Shahid Beheshty Hospital, Kashan University of Medical Sciences, Kashan Iran Tel: +91-471 2524 551 Fax: +91-471 2550 728 E-mail: firstname.lastname@example.org IJTCVS 097091342210305/41
Received - 00/00/06; Review Completed - 00/0/06; Accepted - 00/00/06.
Fig. 1. Image of chest X-ray PA suggested left parahilar mass, before operation.
Fig. 2. Image of CTScan suggested left parahilar mass, before operation.
Follow up with chest X ray, every 3 months in first year and then every 6 months has been performed up to now. There has been no change in its size. (Fig. 3).
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conservative pulmonary resection 3 . Recently, pulmonary artery aneurysm had been treated with Dacron10, and pericardial patch11. Conclusion Pulmonary artery aneurysm may present as a lung mass. It should be considered in differential diagnosis for a lung malignancy. Although some reports support conservative treatment 15,16,17. Surgery is generally considerd life saving3 and to prevent possibility rupture and sudden death. Intra operatively when the surgeon confronted with a unexpected pulmonary artery aneurysm, surgical repair with Mersilene mesh is recommended. Because it is an easy, safe, reliable and avoids resection. References
Fig. 3. Chest X-ray in 2005. 1. Arom KV, Richardson JD, Grove FL, Ferris G, Trinkke JK. Pulmonary artery aneurysm. Am Surg 1978; 44: 68892. 2. Fang CC, Tsai CC. Idiopathic pulmonary artery aneurysm. J Formosan Med Assoc 1996; 95: 87376. 3. Ungaro R. Solitary peripheral pulmonary artery aneurysms: pathogenesis and surgical treatment. J thorac Cardiovasc Surg 1976; 71: 566. 4. Hassine E, Bousnina S, Marniche K, Fennira H, Ben Khelil J, Ben Mustapha MA, Megdiche ML, Chabbou A. Pulmonary artery aneurysms in Behcet's disease: contribution of imaging in 5cases: Ann Med Interne 2002; 153(3): 14752. 5. Natelson EA, watts HD,fred HL : cystic media necrosis of the pulmonary arteries. Chest 1970. 57: 333. 6. Veldtman GR, Dearani JA, Warnes CA: Low pressure giant pulmonary artery aneurysms in the adult: natural history and management strategies; Heart 2003; 89(9): 106770. 7. Remy JM, Remy J. Spiral CT angiography of the pulmonary circulation. Radiology 1999; 212: 61536 8. Barbier-GH;Shettigar-UR; Echocardiographic diagnosis of pulmonary artery aneurysm. J-Fla-med-Assoc 1995; 82(7): 47072. 9. Shah HR, Stark JE, Buckner CB. Magnetic resonance imaging of pulmonary artery aneurysm. Sosa:South-Med- J 1991; 84(8): 1026 28. 10. Hamawy AH, Cartledge RG, Girardi LN. Graft repair of a pulmonary artery aneurysm Heart Surg Forum 2002; 5(4): 39698. 11. Agarwal S, Chowdhury UK, Saxena A, Ray R, Sharma S, Airan B. Isolated idiopathic pulmonary artery aneurysm. Asian Cardiovasc Thorac Ann 2002; 10(2): 16769. 12. Casselman-F,Meyns-B,Herygers-P. Pulmonary Artery Aneurysm: is surgery always indicated? Acta-Cardiol 1997; 52(5); 43136. 13. Khalil MZ,Al-Nozha MM,Wani BA :Asymptomatic giant pulmonary artery aneurysm in an elderly male patient. Saudi Med J 2004; 25(6): 802. 14. Holm F, Palecek T, Linhart A, Reznicek V, Aschermann M. Idiopathic aneurysm of the pulmonary artery; Vnitr Lek 2003; 49(3): 24447. 15. Chung-cw; Doherty-Ju; Koter-R; Finkelstein-A; Dresdale-A; Pulmonary artery aneurysm presenting as a lung mass. Chest 1995; 108(4): 116466.
Discussion Pulmonary artery aneurysm is rare condition. It may be congenital or acquired in origin. Acquired pulmonary artery aneurysm is more common and may be associated with cardiovascular diseases, long standing pulmonary hypertension 1 , syphilis tuberculosis 3 , Behcet"s disease4 cystic medial-necrosis of pulmonary arteries5. Idiopathic pulmonary artery aneurysm is extremely rare and only limited cases have been reported in english literature. The clinical symptoms of pulmonary artery aneurysm, such as hemoptysis dyspnea on exertion, Chest wall pain, fever, or cough have been reported6. Pulmonary artery aneurysm can be diagnosed by Magnetic Resonance Imaging (MRI), and digital subtraction pulmonary angiography preoperately7,8,9. It may be mistaken with lung tumor and discovered during thoracotomy. It must be considered as a differential diagnosis in an enlarged pulmonary hilar mass on chest radiogram. Surgical is generally considered life saving by the preventing rupture of the aneurysm. Resection of the aneurysm and1 pneumoectomy with complete cure had been achieved. Some reports support conservative treatment12,13,14. However, the long-term follow-up is necessary. Peripheral and often solitary aneurysms rupture in 60% of patients, Ungaro3 emphasized the necessity of definitive diagnosis and early treatment with
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