PMC6500601_01
Contrast-enhanced axial computed tomography image. There is a 7 mm round aneurysm (arrow) within a cavitary lesion in the left upper lobe of the lung.
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C-reactive protein. Contrast-enhanced computed tomography (CT) revealed a 7 mm round pseudoaneurysm within a cavitary lesion in the left upper lobe of the lung (Figure 1).
Volume rendering reconstructed image of the computed tomography angiography. The aneurysm (arrow) seems to originate from a branch of the left superior segmental pulmonary artery (arrowhead).
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The pseudoaneurysm was thought to originate from a branch of the left superior segmental pulmonary artery (Figure 2).
Bronchial angiography. (a) The early phase depicts the aneurysm (arrow) via small and tortuous anastomoses (arrowheads) from the left bronchial artery. (b) The delayed phase shows the parent pulmonary artery of the aneurysm (arrow) via a shunt from the left bronchial artery.
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However, we could not advance the microcatheter to a more peripheral branch near the lesion, because the anastomosis was small and tortuous (Figure 3).
Comparison between pulmonary angiography and computed tomography image. (a) Left segmental pulmonary angiography shows abrupt tapering of the arterial branch (arrow), which indicates retrograde flow from the bronchial to the pulmonary artery. (b) Contrast-enhanced coronal computed tomography image shows the aneurysm (arrow) and the parent artery of the aneurysm (arrowhead). The parent artery corresponds to the abrupt tapering of the arterial branch, which was seen in the left segmental pulmonary angiography.
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The tapering was in the branch that was suspected as the parent artery of the aneurysm on CT (Figure 4).
Embolization of the aneurysm. (a) Two microcatheters are placed in the aneurysm and pulmonary artery proximal to the aneurysm. One microcatheter is used for proximal segmental pulmonary artery coil blocking proximal to the aneurysm (arrow); the other microcatheter is positioned into the aneurysm (arrowhead) before injecting a mixture of NBCA and iodized oil. (b) Complete filling of the aneurysm with the mixture of NBCA and iodized oil (arrow) is performed using the other microcatheter. NBCA, n-butyl-2-cyanoacrylate.
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Thereafter, a 0.8 mL mixture of NBCA and iodized oil (Lipiodol, Guerbet Japan, Tokyo, Japan) (NBCA:Lipiodol = 1:3) was retrogradely injected into the aneurysm through the remaining 1.9-Fr microcatheter. The aneurysm was filled with the mixture of the NBCA and iodized oil, but the feeding artery could not be embolized retrogradely (Figure 5).
Postembolization assessment. There is no residual aneurysm on pulmonary angiography.
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Although postembolization bronchial angiography could not be performed due to the subintimal injury in the left bronchial artery, postembolization pulmonary angiography did not show the residual aneurysm (Figure 6).
Non-contrast-enhanced axial computed tomography image. Two months after the treatment, the aneurysm is filled with the mixture of n-butyl-2-cyanoacrylate and iodized oil (arrow).
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Follow-up CT performed 2 months later confirmed successful embolization of the aneurysm (Figure 7).