PMC8437821_01
Chest x-ray image shows consolidation in the right mid and lower zones (A). Computed tomography shows consolidation and an air bronchogram in the middle lobe of the right lung (B).
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C-reactive protein (CRP) concentration (13.0 mg/dL), prothrombin time-international normalized ratio (1.41), activated partial thromboplastin time (36 seconds), and fibrinogen concentration (475 mg/dL). Chest radiography showed homogeneous opacity consolidation in the right mid and lower zones (Fig. 1A), and chest CT showed consolidation, with an air bronchogram in the middle lobe of the right lung (Fig. 1B).
Multi-detector computed tomography angiography (MDCTA) on day 30 shows an enhanced nodule inside the lung abscess (yellow arrow) (A) and the pulmonary artery pseudoaneurysm (PAP) (white arrow) (B). Pulmonary angiography demonstrates the PAP (C). Blood flow almost disappears after successful transcatheter arterial embolization (D). (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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The following day, MDCTA indicated an enhanced nodule inside the abscess, suggestive of a PAP (Fig. 2A and B). We urgently performed pulmonary angiography, which confirmed the presence of a PAP (Fig. 2C). Bloomington, IN), Histoacryl(R) (B. Braun Aesculap, Melsungen, Germany), and Lipiodol(R) Ultra Fluid (Guerbet, Villepinte, France) (Fig. 2D).
Patient's clinical course. During antibiotic treatment for the lung abscess, the patient suddenly developed massive hemoptysis on day 29. A pulmonary artery pseudoaneurysm was detected by multi-detector computed tomography angiography and was treated with transcatheter arterial embolization (TAE) on day 30 with no recurrence. The abscess was no longer detectable using chest computed tomography on day 98. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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Approximately 2 months after the embolization, the patient had not experienced recurrent hemoptysis, and a repeat chest CT was unable to detect the abscess (Fig. 3).