David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA.
Department of Interventional Radiology, Keck Hospital of USC, Los Angeles, CA.
J Radiol Case Rep. 2023 Aug 31;17(8):8-14. doi: 10.3941/jrcr.v17i8.4687. eCollection 2023 Aug.
First-line treatment of pulmonary artery aneurysms/pseudoaneurysms (PAA/PAPA) is percutaneous or endovascular embolization. The present case of a Rasmussen aneurysm, a PAPA caused by Tuberculosis (TB), was successfully treated with ethylene-vinyl alcohol (EVOH), a radiopaque liquid embolic agent with favorable characteristics. A 35-year-old man presented as a new patient with hemoptysis, and CT imaging revealed multiple cavitary lesions and a 2.1 cm aneurysm in the upper right lobe. Endovascular treatment was delivered and a complete lack of filling of the lesion was noted on post-treatment angiography. The patient's history includes risk factors and past TB infection. Despite the suspicious imaging, diagnostic tests were negative for active TB in this patient. He was then found to have MRSA bacteremia and a mediastinal lymph node positive for M. avium. The etiology of this aneurysm is suspicious for the superinfection of a chronic tuberculous cavity with M. avium, MRSA, or both.
肺动静脉瘤/假性动脉瘤（PAA/PAPA）的一线治疗方法是经皮或血管内栓塞。本病例为朗格汉斯动脉瘤，是由结核（TB）引起的 PAPA，成功地使用乙烯-乙烯醇（EVOH）进行了治疗，EVOH 是一种具有良好特性的不透射线液体栓塞剂。一名 35 岁男性因咯血就诊，CT 成像显示右上叶有多个空洞性病变和 2.1 厘米的动脉瘤。进行了血管内治疗，治疗后血管造影显示病变完全无填充。该患者有危险因素和既往结核感染史。尽管影像学可疑，但该患者的诊断检测均为活动性结核阴性。随后发现其患有耐甲氧西林金黄色葡萄球菌菌血症和纵隔淋巴结对鸟分枝杆菌呈阳性。该动脉瘤的病因疑似为慢性结核性空洞合并鸟分枝杆菌、耐甲氧西林金黄色葡萄球菌或两者的继发感染。
