PMC4681976_01
(a) Chest x-ray demonstrating calcification in the hilum, (b) large biapical cavities, left larger than right.
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There were mild hilar calcifications which were thought to be associated with old histoplasmosis. (Fig. 1a) Chest x-ray during the current admission revealed bilateral upper lobe opacities (Fig. 1b).
(a) CT axial view demonstrating thick cavitary lesions in the both upper lobes. (b) CTA axial views demonstrating a contrast filled aneurysm in the left upper lobe (c) CTA sagittal view demonstrating with left upper lobe aneurysm.
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Computed tomographic angiography (CTA) was done which showed biapical cavitary lesions with infiltrates and pulmonary artery aneurysms (Fig. 2 a, b and c).
(a) Bronchial angiogram demonstrating a large aneurysm (b) digital angiography of the same aneurysm.
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Her hemoptysis rapidly worsened, and she was emergently intubated and taken to the interventional radiology where a pulmonary angiogram confirmed three left upper lobe aneurysms, two of which were actively bleeding (Fig. 3a and b demonstrate one of the aneurysms).
Digital subtraction angiography demonstrating a non filling aneurysm. After glue injection.
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She underwent emergent glue embolization of all three aneurysms (Fig. 4).