PMC8053241_01
CTPA. A) Non-occlusive filling defect within the segmental branch of the middle lobe pulmonary artery within the right lung, in keeping with pulmonary embolus/immunothrombus (yellow arrow). B) Diffuse bilateral peripheral patchy ground glass attenuation, consolidation and subpleural reticulation consistent with COVID-19 pneumonitis. Note is made of bilateral pleural effusions, likely secondary to concomitant fluid overload (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.).
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One week into ICU admission, due to persistently low saturations and a rising D-dimer, a CT pulmonary angiogram (CTPA) was performed (Fig. 1).
Repeat CTPA. A) Left apical pulmonary artery pseudoaneurysm measuring 8 mm (yellow arrow). B) Left apical pneumatocele adjacent to the pseudoaneurysm (red arrow) (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.).
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This illustrated an 8 mm left upper lobe pulmonary artery pseudoaneurysm with an adjacent left apical pneumatocele (Fig. 2).
Endovascular embolisation of the left apical pulmonary artery pseudoaneurysm.. A) Pulmonary artery angiogram confirming a small pseudoaneurysm arising from a branch of the left upper lobe pulmonary artery. B) Pseudoaneurysm selectively cannulated and embolised with an 8mm Amplatzer   IV vascular plug. C) Satisfactory post-embolisation angiographic result demonstrating reduced flow of contrast within the pseudoaneurysm.
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Anticoagulation was withheld and the patient underwent emergency embolisation of the pseudoaneurysm in interventional radiology (Fig. 3).
Interval CTPA performed 2 weeks following the embolisation. A) No filling of contrast is seen at the site of the previously demonstrated left upper lobe pseudoaneurysm. B) Amplatzer   IV plug in situ in the left upper lobe pulmonary artery branch (yellow arrow) (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.).
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An interval CTPA demonstrated no contrast filling the previously seen pseudoaneurysm secondary to the successful placement of the Amplatzer  IV plug (Fig. 4).