Giant high-pressure pulmonary artery aneurysm (PAA) in a patient with COPD and chronic pulmonary embolism (PE)

• Published in: BMJ case reports 2022-03, Vol.15 (3), p.e245673
• Main Authors: Fong, Hee Kong, Pinson, Amber, Bhardwaj, Bhaskar, Samad, Fatima
• Format: Article
• Language: English
• Subjects: Aneurysm - complications; Aneurysm - diagnostic imaging; Case Reports: Rare disease; Female; Foramen Ovale, Patent - complications; Humans; Pulmonary Artery - diagnostic imaging; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Embolism - complications; Pulmonary Embolism - diagnostic imaging
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-245673

A woman in her 60s with a history of known severe chronic obstructive pulmonary disease (COPD), former smoker of 50 pack-years and small patent foramen ovale (PFO) without significant shunt was admitted for acute on chronic hypoxic respiratory failure. Diagnostic workup showed severe dilatation of main pulmonary artery (MPA) (75.5 mm axial view and 86.6 mm sagittal view) and left and right PAs measuring 40 mm and 34 mm, respectively, on CT angiography of the chest. Right heart catheterisation showed severe pulmonary hypertension (PH). A diagnosis of giant high-pressure pulmonary arterial aneurysm (PAA) secondary to PH, induced by COPD, and chronic pulmonary embolism was made. Despite aggressive medical management, she passed away on comfort care. Giant high-pressure PAAs are rarely reported. This is a unique case that demonstrates this very rare condition in a living patient. The management of giant PAA is controversial. Experts recommend medical management or aneurysmectomy for sizes of >55-60 mm. Death could have been prevented if our patient was screened earlier and received appropriate medical care.