Pulmonary artery pseudoaneurysm and shock bowel in a multitrauma patient

Case contributed by Dr Dayu Gai

Presentation

This 37 year old male was brought into hospital after being stabbed in the back (right sided, mid clavicular line). A CT trauma series was performed.

Patient Data

Age: 35
Gender: Male

Traumatic haematopneumatocele within the right lower lobe, with a focus of contrast cavitation with a density in keeping with a likely traumatic pseudo aneurysm. It measures 1.5 x 1 .5 cm which follows the density of the aorta on both the arterial and portal venous phase. Right sided intercostal catheters are present, with the anterior intercostal catheter initially within lung parenchyma.

Right sided haemopneumothorax.

Moderate ascites. Loops of bowel with radiological features suggestive of 'shocked bowel'.

Case Discussion

This patient has a pulmonary artery pseudoaneurysm (PAP). PAPs are uncommon, however are most commonly associated with cardiovascular dysfunction. Other causes of PAP include:

  • infection
  • iatrogenic
  • trauma (usually penetrating trauma > blunt trauma)
  • neoplasm

The literature documents several cases which have been associated with penetrating injury, such as gunshot wounds to the chest1,2.

Clinically, patients most commonly present with haemoptysis, although this one was found during initial scanning post motor vehicle accident.

PAPs are clinically relevant due to the risk of the lesion rupturing, leading to exsanguination and death. Thus, management of PAPs includes interventional management with coil embolisation and surgical management with surgical ligation, wedge resection or lobectomy.

Case contributed by A/Prof. Pramit Phal.

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Case Information

rID: 30858
Case created: 7th Sep 2014
Last edited: 24th Nov 2015
Inclusion in quiz mode: Excluded

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