PMC9356258_01
Frontal chest radiograph (A) shows reticular opacities in both upper zones. Axial sections of HRCT Chest (B, C, D) show reticular opacities in both lung fields with septal thickening and multiple areas of traction bronchiectasis. A thin-walled cavity is seen the right lower lobe (black arrow in C).
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On reviewing the CTPA films that the patient had come with (Fig. 1), we noticed a dilated pulmonary artery and cardiomegaly.
Axial section of CT Pulmonary Angiogram (A) shows dilated main and left pulmonary artery. Axial (B) and coronal (C) sections of CTPA shows pulmonary artery pseudoaneurysm arising in the left upper lobe.
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This was diagnosed to be a pseudoaneurysm arising from a segmental branch of the upper lobar branch of left pulmonary artery (Fig. 2).
(A) Catheter Pulmonary Angiogram shows PAPA (white arrows) arising from a segmental branch of the left upper lobe. (B) Selective angiogram performed after cannulation of the abnormal feeding artery of the PAPA. (C) Endovascular coil embolization of the PAPA, with glue embolization of the PAPA and dysplastic artery. (D) Check pulmonary angiogram shows complete occlusion of the aneurysm.
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The pseudoaneurysm was treated by the interventional radiologists with endovascular coil embolization of the PAPA, and glue embolization of the PAPA and dysplastic artery (Fig. 3).
Follow up chest radiograph (A) and axial HRCT Chest (B) shows metallic coils in left upper lobe with reduced lung fibrosis.
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A repeat echocardiography showed good biventricular function and a repeat high resolution CT of the lungs showed significant resolution of fibrosis (Fig. 4).