Pseudoaneurysm of the aortic arch

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Abstract

Background:

Pseudoaneurysm of the aortic arch is uncommonly associated with cancer, and is extremely rare in pulmonary cancer. Here, we report an unusual and successfully treated case of aortic arch pseudoaneurysm in a male patient with lung squamous cell carcinoma.

Methods:

A 64-year-old male patient was admitted to the Emergency Department, presenting with massive hemoptysis (>500 mL blood during the 12 hours prior to treatment). The diagnosis of aortic arch pseudoaneurysm was confirmed after inspection of computed tomographic angiography and three-dimensional reconstruction. We processed the immediate endovascular stent-grafting for this patient.

Results:

This patient recovered with no filling or enlargement of the pseudoaneurysm, no episodes of hemoptysis, and no neurological complications during the 4-week follow-up period.

Conclusion:

Herein, we compare our case with other cancer-related pseudoaneurysms in the medical literature and summarize the clinical features and treatment of this unusual case.

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Most cited references 15

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Massive hemoptysis: an update on the role of bronchoscopy in diagnosis and management.

L Sakr, H. Dutau (2009)

Hemoptysis is frequently encountered in clinical practice, and may be the presenting symptom of a number of diseases. Although massive hemoptysis accounts for only 5-15% of episodes, it should always be considered as a life-threatening condition that warrants effective assessment and management. In this article, we review the literature with regard to the definition, etiology, epidemiology, pathophysiology, diagnosis and treatment of massive hemoptysis, with special emphasis on the role of bronchoscopy as a diagnostic and therapeutic tool. We briefly present the circumstances under which the use of rigid bronchoscopy should be preferred for controlling massive bleeding. Moreover, we address the crucial importance of multidisciplinary collaboration by illustrating the roles of endovascular therapy and surgery in the optimal management of massive hemoptysis.

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Surgical treatment of pseudoaneurysm of the thoracic aorta.

Fernando A. Atik, Jose L. Navia, Lars G Svensson … (2006)

To examine the clinical profiles, operative outcomes, and late results of patients with pseudoaneurysm of the thoracic aorta. From 1990 to 2002, 60 patients underwent repair of aortic pseudoaneurysm: ascending aorta in 70%, ascending aorta and arch in 15%, descending aorta in 10%, and arch alone in 5%. Mean age was 53 +/- 15 years, and 70% were men. Of these, 50 (83%) had undergone previous cardiac surgery, including 22 (37%) composite valve graft operations. The preferred cannulation site was femoral-femoral (n = 27, 45%), with deep hypothermic circulatory arrest in 62% and retrograde cerebral perfusion in 33%; more recently, however, axillary cannulation has been preferred. Principal etiologies were graft infection in ascending aorta pseudoaneurysm and trauma in descending aorta pseudoaneurysm. Fifteen patients (25%) presented with chest pain, 13 (22%) with heart failure, and 20% with moderate or severe aortic regurgitation. The pseudoaneurysm was resected and the aorta replaced (n = 45, 75%) or repaired (n = 15, 25%) using various methods. Hospital mortality was 6.7% (n = 4). Reexploration for bleeding was required in 8.3%, and 3.3% had postoperative stroke. At 30 days, 5 years, and 10 years, survival was 94%, 74%, and 60% and freedom from reoperation was 95%, 77%, and 67%, respectively. Most patients with aortic pseudoaneurysm require ascending aorta and/or arch replacement, which can be accomplished with low operative mortality and morbidity. Long-term survival and freedom from reoperation in these young patients parallel those expected for complex cardiac and aortic disease.

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Severe hemoptysis: From diagnosis to embolization

A. Khalil, B. Fedida, A Parrot … (2015)

Severe hemoptysis is life-threatening to patients because of the asphyxia it causes. The diagnosis and treatment are therefore urgent and chest imaging is essential. Multidetector CT-angiography provides an exhaustive non-invasive assessment which includes localization, mechanisms, causes and severity of the hemoptysis. It is an invaluable step in preparation for endovascular treatment which is the first line invasive therapy, particularly with bronchial arteriography embolization in the majority of cases (over 90%) and erosion or rupture of the pulmonary artery in less than 10% of cases. Hemoptysis control is achieved in 65 to 92% of cases depending on the cause.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: August 2016

Publication date (Electronic): 07 August 2016

Volume: 95

Issue: 31

Electronic Location Identifier: e4457

Affiliations

Department of Emergency Medicine, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China.

Author notes

[∗ ]Correspondence: Yuan-Qiang Lu, Department of Emergency Medicine, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, People's Republic of China (e-mail: luyuanqiang201hotmail.com or luyuanqiang@ 123456aliyun.com ).

Article

Accession ID: 04457

DOI: 10.1097/MD.0000000000004457

PMC ID: 4979833

PubMed ID: 27495079

SO-VID: 8320b5b5-c83a-4e0e-9cf3-2c3eb9814788

License:

This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

History

Date received : 15 April 2016

Date revision received : 24 June 2016

Date accepted : 5 July 2016

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Keywords: aortic arch pseudoaneurysm,computed tomographic angiography,endovascular stent-grafting,hemoptysis,pulmonary cancer

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Keywords: aortic arch pseudoaneurysm, computed tomographic angiography, endovascular stent-grafting, hemoptysis, pulmonary cancer

Pseudoaneurysm of the aortic arch : A rare case report of pulmonary cancer complication

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Most cited references 15

Massive hemoptysis: an update on the role of bronchoscopy in diagnosis and management.

Surgical treatment of pseudoaneurysm of the thoracic aorta.

Severe hemoptysis: From diagnosis to embolization

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