Key message
Physicians should consider a pulmonary artery aneurysm complication in patients presenting with hemoptysis during treatment for a pulmonary abscess. Contrast‐enhanced CT or angiography is recommended for diagnosis, followed by pulmonary embolization for treatment.
Keywords: lung abscess, pulmonary artery aneurysm, transcatheter arterial embolization
Although rare, physicians should remain vigilant for pulmonary artery aneurysm when treating a lung abscess and the patient presents with hemoptysis.
CLINICAL IMAGE
A 58‐year‐old Japanese man, a 40 pack/year smoker, came to our hospital with a fever and productive cough. A chest computed tomography (CT) scan showed a cavity surrounded by consolidations in the left upper lung (Figure 1). The patient displayed peripheral blood leukocytosis and elevated C‐reactive protein levels (11.3 mg/dL), leading to a diagnosis of a lung abscess. Treatment with tazobactam/piperacillin (13.5 g/day) initially showed improvement. However, on day 16, the patient experienced sudden hemoptysis. Contrast‐enhanced CT (Figure 2A) and angiography (Figure 2B) revealed a pulmonary artery aneurysm (PAA) within the abscess. Consequently, a transcatheter arterial embolization (TAE) was conducted. Following another week of antibiotic treatment, the PAA was no longer detectable on a chest CT scan by day 23 (Figure 3). Even though the occurrence of PAA is rare, at 0.007%, 1 several instances have been reported where it is associated with lung inflammation. 2 , 3 Thus, physicians should remain vigilant for PAA when treating a lung abscess and the patient presents with hemoptysis.
FIGURE 1.
Chest computed tomography (CT) from 2 years ago shows a low attenuation area in both lungs. Upon admission, a cavity surrounded by consolidations in the left upper lung was evident.
FIGURE 2.
On day 16, contrast‐enhanced CT (A) displayed a nodule with a contrast effect within the abscess (yellow circles). Angiography (B) identified a pulmonary artery aneurysm (red circle).
FIGURE 3.
Clinical progression: Tazobactam/piperacillin (4.5 g/day) was administered for the lung abscess upon admission. By day 16, after the patient experienced hemoptysis, a contrast‐enhanced chest CT indicated an aneurysm within the abscess, prompting a transcatheter arterial embolization. By day 23, the chest CT revealed a significant improvement in the left upper lung consolidation. Additionally, both the patient's white blood cell count and serum C‐reactive protein levels were within the normal range. The treatment was then switched to oral garenoxacin (400 mg/day).
AUTHOR CONTRIBUTIONS
Yuki Hayakawa is responsible for the conception or design of the work, and for the acquisition, analysis, and interpretation of the data for the work. Kei Yamasaki is responsible for drafting the work and revising it critically for important intellectual content. Midori Funada is responsible for revising it critically for important intellectual content. Masaya Komatsu is responsible for revising it critically for important intellectual content. Yukinori Maeda is responsible for revising it critically for important intellectual content. Kazuhiro Yatera is responsible for final approval of the version to be published.
CONFLICT OF INTEREST STATEMENT
None declared.
ETHICS STATEMENT
The authors declare that appropriate written informed consent was obtained for the publication of this manuscript and accompanying images.
Hayakawa Y, Yamasaki K, Funada M, Komatsu M, Maeda Y, Yatera K. Pulmonary artery aneurysm induced by lung abscess. Respirology Case Reports. 2023;11:e01213. 10.1002/rcr2.1213
Associate Editor: Jennifer Ann Wi
DATA AVAILABILITY STATEMENT
Data sharing not applicable ‐ no new data generated, or the article describes entirely theoretical research
REFERENCES
- 1. Deterling RA, Clagett OT. Aneurysm of the pulmonary artery; review of the literature and report of a case. Am Heart J. 1947;34:471–499. 10.1016/0002-8703(47)90527-9 [DOI] [PubMed] [Google Scholar]
- 2. Monchik J, Wilkins EW. Solitary aneurysm of the middle lobe artery. A case report and review of solitary peripheral pulmonary artery aneurysms. Ann Thorac Surg. 1974;17:496–503. 10.1016/s0003-4975(10)65686-x [DOI] [PubMed] [Google Scholar]
- 3. Oguma T, Morise M, Harada K, Tanaka J, Sato M, Horio Y, et al. Pulmonary artery aneurysm/pseudoaneurysm, a delayed complication of lung abscess: a case report. Tokai J Exp Clin Med. 2015;40(3):86–89. [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing not applicable ‐ no new data generated, or the article describes entirely theoretical research