Presentation
Found unresponsive at home. Known history of intravenous drug use.
Patient Data
There is near complete collapse of the right lower lobe. There are bilateral cystic parenchymal lesions with air-fluid levels, as well as scattered pulmonary nodules. There is a small right pleural effusion and mild, diffuse thickening of the airways. The pulmonary vasculature appears within normal limits.
There are multiple hypodensities throughout the spleen. The largest hypodensity is wedge-shaped and thought to represent a large infarct. There is no adjacent hemorrhage or findings of active extravasation of contrast to suggest that these represent acute traumatic findings.
Partially imaged enteric tube is again noted to be coiled back upon itself within the esophagus, and the distal aspect is not included in the field-of-view.
Pulmonary arteries are well opacified and no filling defects are identified. However, there are multiple irregularly shaped saccular aneurysms of both left and right pulmonary arteries that are new since prior examination. Other similar but smaller aneurysms or pseudoaneurysms include the lateral segment of the right middle lobe, superior segment right lower lobe, posterior segment right upper lobe, lingular artery.
There is virtually complete atelectasis of the left lower lobe associated with a pleural effusion. There is mixed atelectasis and consolidation in the right upper, middle, and lower lobes. There are several smaller cystic lesions, with the largest cavitary lesion in the right middle lobe. There is a moderate-to-large left- and mild right-sided pleural effusions.
Case Discussion
This is a case of several mycotic aneurysms. The patient has a history intravenous drug use. On the initial CT, pulmonary abscesses were seen but there were no obvious aneurysmal dilations in the pulmonary vasculature. Approximately 1 month later, the patient developed multiple bilateral mycotic pulmonary pseudoaneurysms which eventually caused severe hemoptysis with decreasing respiratory status. She had an emergent stent graft exclusion and coil embolization of multiple right pseudoaneurysms. Following this, the patient's respiratory status improved and was eventually discharged without recurrence of symptoms.
Co-authors:
Guy Gechtman
Camille Dumas, DO
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