PMC5173504_01
Chest CT at first admission (a), second admission (b), three months after the second admission (c), and five months after the second admission (d). The arrows indicate the left pulmonary artery.
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Chest computed tomography (CT) showed pulmonary embolism and thickening of the pulmonary artery walls (Fig. 1a). CRP 6.3 mg/dL, erythrocyte sedimentation rate (ESR) 107 mm/hr, and D-dimer 7.9 mug/mL. Chest CT showed prominent aneurysms and thickening of the pulmonary artery walls (Fig. 1b) with consolidation predominantly located in the right middle lobe, findings which were all suggestive of hemorrhage. The pulmonary artery aneurysm and thrombosis gradually resolved, and nearly returned to normal state at the end of cyclophosphamide pulse therapy, which was five months after starting treatment (Figure 1c and d, 3).
Expansion of the pulmonary arteries. The right and left pulmonary arteries (arrows) had slightly expanded two months after first admission and clearly expanded five months after first admission (one week before second admission).
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During follow-up, the patient continued to have bloody sputum, CRP remained elevated at 3 to 6 mg/dL, and gradual expansion of the pulmonary arteries was noted on chest X-ray (Fig. 2).
Resolution of the pulmonary artery aneurysms. At second admission, chest X-ray showed consolidation in the right lower lung field (left). The left pulmonary artery aneurysm (arrows) had shrunk in size at 3 months after beginning therapy with corticosteroids and cyclophosphamide. The aneurysm appeared to be resolved at the end of the cyclophosphamide pulse therapy regimen, which was five months after starting treatment.
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Chest X-ray showed consolidation in the right lower lung field (Fig. 3, left). The pulmonary artery aneurysm and thrombosis gradually resolved, and nearly returned to normal state at the end of cyclophosphamide pulse therapy, which was five months after starting treatment (Figure 1c and d, 3).