Pallangyo Pedro, Lyimo Frederick, Bhalia Smita, Makungu Hilda, Nyangasa Bashir, Lwakatare Flora, Suranyi Pal, Janabi Mohamed
Department of Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.
Department of Radiology, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania.
J Med Case Rep. 2017 Jul 19;11(1):196. doi: 10.1186/s13256-017-1360-x.
Pulmonary artery aneurysms constitute <1% of aneurysms occurring in the thoracic cavity. Congenital cardiac defects are responsible for the majority (>50%) of cases, however, pulmonary artery aneurysm is a rare sequelae of pulmonary tuberculosis reported in about 5% of patients with chronic cavitary tuberculosis on autopsy. The natural history of this potentially fatal condition remains poorly understood and guidelines for optimal management are controversial.
A 24-year-old man, a nursing student of African descent, was referred to us from an up-country regional hospital with a 4-week history of recurrent episodes of breathlessness, awareness of heartbeats and coughing blood 3 weeks after completing a 6-month course of anti-tuberculosis drugs. A physical examination revealed conjuctival and palmar pallor but there were no stigmata of connective tissue disorders, systemic vasculitides or congenital heart disease. An examination of the cardiovascular system revealed accentuated second heart sound (S) with early diastolic (grade 1/6) and holosystolic (grade 2/6) murmurs at the pulmonic and tricuspid areas respectively. Blood tests showed iron deficiency anemia, prolonged bleeding time, and mild hyponatremia. A chest radiograph revealed bilateral ovoid-shaped perihilar opacities while a computed tomography scan showed bilateral multiple pulmonary artery pseudoaneurysms with surrounding hematoma together with adjacent cystic changes, consolidations, and tree-in-bud appearance. Our patient refused to undergo surgery and died of aneurismal rupture after 9 days of hospitalization.
The presence of intractable hemoptysis among patients with tuberculosis even after completion of anti-tuberculosis course should raise an index of suspicion for pulmonary artery aneurysm. Furthermore, despite of its rarity, early recognition and timely surgical intervention of pulmonary artery aneurysm is crucial to reducing morbidity and preventing the attributed mortality.
肺动脉瘤占胸腔内动脉瘤的比例不到1%。先天性心脏缺陷是大多数（>50%）病例的病因，然而，肺动脉瘤是肺结核的一种罕见后遗症，据报道，在慢性空洞性肺结核患者尸检中约5%的患者出现此情况。这种潜在致命疾病的自然病程仍知之甚少，最佳治疗指南也存在争议。
一名24岁的男性，是一名非洲裔护理专业学生，在完成6个月抗结核药物疗程3周后，因反复出现气短、心悸和咯血4周，被一家偏远地区医院转诊至我院。体格检查发现结膜和手掌苍白，但无结缔组织病、系统性血管炎或先天性心脏病的体征。心血管系统检查发现第二心音亢进（S），分别在肺动脉和三尖瓣区有舒张早期（1/6级）和全收缩期（2/6级）杂音。血液检查显示缺铁性贫血、出血时间延长和轻度低钠血症。胸部X线片显示双侧肺门周围椭圆形阴影，而计算机断层扫描显示双侧多发肺动脉假性动脉瘤伴周围血肿，以及相邻的囊性改变、实变和树芽征。我们的患者拒绝接受手术，住院9天后死于动脉瘤破裂。
即使在完成抗结核疗程后，肺结核患者出现难治性咯血也应提高对肺动脉瘤的怀疑指数。此外，尽管肺动脉瘤罕见，但早期识别和及时手术干预对于降低发病率和预防相关死亡率至关重要。
