Spontaneous Resolution of a Blunt Traumatic Main Pulmonary Artery Pseudoaneurysm

A 73-year-old man with paradoxical breathing following blunt trauma was transferred to our emergency department. He was hemodynamically stable and showed no hemoptysis. Chest contrast-enhanced computed tomography (CECT) revealed multiple rib fractures with pneumothorax, and left main pulmonary artery pseudoaneurysm (PAP) of 18 mm diameter. Internal pneumatic stabilization for flail chest was achieved and the starting positive end-expiratory pressure (PEEP) was above 10 cmH2O. Traumatic PAP (tPAP) was resolved gradually 10 days later, and regained normal diameter 2 months later (Figure 1). Initial contrast-enhanced computed tomography (CT) of the chest revealed the left main pulmonary artery (PA) aneurysm (arrow) and mediastinum hematoma. Three-dimensional CT of the PA also revealed an irregular shaped aneurysm (arrow) indicating pseudoaneurysm. Pulmonary artery pseudoaneurysm is a lethal complication of cardiac diseases, infection, iatrogenic injuries, or penetrating trauma.1, 2 Traumatic PAPs may form when re-epithelialization of the perforation does not occur, and are commonly located in the periphery.2 Angiography can be definitive diagnostic modality of CECT and transection, rupture or dissection of the PA can be discrimination. Clinical presentation could be asymptomatic or include hemoptysis, and massive hemoptysis resulting in high mortality could suggest tPAP rupture.3 Depending on etiology, size, and intravascular pressure, tPAP could stabilize and resolve or expand and rupture.3 Standard treatment is endovascular embolization rather than surgery, and conservative management can be selected depending on location, size, or lack of symptoms.4, 5 Decreasing intravascular pulmonary artery pressure using PEEP could avoid tPAP rupture nonoperatively. The authors would like to thank Enago for the English language review. The authors declare no conflicts of interest. Approval of the research protocol: N/A. Informed consent: Written informed consent was obtained from the patient for publication of this case report and accompanying images. Registry and registration no. of the study/trial: N/A. Animal studies: N/A. Data openly available in a public repository that issues datasets with DOIs.