Asian Cardiovasc Thorac Ann 2007;15:362-363
© 2007 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Traumatic Pseudoaneurysm of Pulmonary Artery
Madan M Maddali, MD,
Sunny Zacharias, FRCS1,
Ravindra K Adhikari, MD,
Muthukkumar C Rajakumar, McH1,
Ahmed R Ahmed, MS1
Department of Anesthesia
1 Department of Cardiothoracic Surgery, Royal Hospital, Seeb, Oman
For reprint information contact: Madan M Maddali, MD Tel: 968 2469 7133 Fax: 968 2469 7133 Email: madan{at}omantel.net.om, Department of Anaesthesia, Royal Hospital, PB.No: 1331, PC: 111, Seeb, Muscat, Sultanate of Oman.
A 35-year old man presented with a stab injury in the posterior aspect of the right chest with the knife in situ (Figure 1
). An emergency thoracotomy was performed, the knife was removed under controlled conditions that possibly saved the patient and parenchymal injuries were dealt with. After four days he developed a right lower lobe collapse with a dense circumscribed opacity in the mid zone radiographically (Figure 2). A contrast enhanced computerized tomogram revealed a 4 x 3 cm hyper dense vascular area posterolateral to the hilum arising from the peripheral branch of the right pulmonary artery (suggestive of a pseudoaneurysm), a right lower lobe collapse with pleural thickening and a hemothorax (Figure 3). It was decided to subject the patient to surgery without attempts at endovascular coil embolization so as to deal with the lung problems and handle the pseudoaneurysm as well.
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Figure 2. Chest radiograph showing a dense opaque shadow in the right lung with right lower lobe collapse.
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Under a narcotic based general anesthesia with standard American Society of Anesthesiologists monitoring guidelines, thoracic epidural analgesia and one lung ventilation a re-thoracotomy was performed. The aneurysm that was arising from the posterior segmental branch of the right upper lobar artery was opened after achieving proximal control and the mouth of the opening was repaired. Postoperative course was uneventful.
