The role of pulmonary CT angiography and selective pulmonary angiography in endovascular management of pulmonary artery pseudoaneurysms associated with infectious lung diseases.

PURPOSE: To determine the value of performing selective angiography based on the findings of pulmonary computed tomographic (CT) angiography for the detection of a pulmonary artery pseudoaneurysm (PAP) associated with infectious lung diseases and to evaluate the usefulness of endovascular management of these PAPs.

MATERIALS AND METHODS: Over a 6-year period, 11 PAPs were diagnosed in 10 patients (seven men and three women; age, 23-84 years). All patients presented with massive hemoptysis. The underlying diseases were cavitary pulmonary tuberculosis (n = 7), lung abscess (n = 2), and a fungus ball (n = 1). The detection rates of PAP by bronchial/thoracic angiography, main pulmonary angiography, and selective pulmonary angiography were analyzed. When a pseudoaneurysm was detected, feeding artery occlusion was performed with coils or n-butyl cyanoacrylate.

RESULTS: The findings of main pulmonary angiography were contrast agent filling of the pseudoaneurysm (n = 4) and hypoperfusion of the diseased pulmonary segment without contrast agent filling of the pseudoaneurysm (n = 6). The selective angiogram based on pulmonary CT angiography demonstrated five cases of pseudoaneurysm that were not found on the main pulmonary angiogram. Embolization of the pseudoaneurysm was successfully performed in nine of the 10 patients. One patient experienced a rupture of the subsegmental branch of the inferior pulmonary artery during the procedure.

CONCLUSION: Because main pulmonary angiography alone may fail to demonstrate a pseudoaneurysm, a selective angiogram based on the anatomic information obtained from pulmonary CT angiography is essential for detection of a pseudoaneurysm. In addition, endovascular management of a PAP appears to be a safe and effective treatment.