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Diagnosis and Emergency Treatment of Ruptured Mucormycotic Pulmonary Pseudoaneurysm
Diagnóstico y tratamiento urgente de la ruptura de un pseudoaneurisma mucormicótico pulmonar
María del Mar García Gallardo
, María Lucía Berma Gascón
Corresponding author
FEA Radiodiagnóstico, Hospital Universitario Virgen de la Victoria, Málaga, Spain
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B) TC tórax con contraste endovenoso (ventana mediastino). Consolidación parenquimatosa pulmonar con colección hipodensa de pared gruesa y realzada en relación con absceso de 6 cm (neumonía necrotizante) y derrame pleural. Lesión de morfología sacular, de 14 mm, en relación con pseudoaneurisma mucormicótico. C) Arteriografía diagnóstico-terapéutica. Lesión de morfología sacular en relación con pseudoaneurisma dependiente de la rama inferior del segmento medial del LID. D) Pseudoaneurisma de menor tamaño respecto a figura C y extravasación del contraste en relación con rotura. E) Embolización mediante dispositivo Amplatzer (flecha negra) y colocación de coils (flecha amarilla) en rama arterial del segmento inferomedial del LID. F) Pieza quirúrgica tras lobectomía inferior derecha. 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B) Contrast-enhanced chest CT (mediastinal window). Pulmonary parenchymal consolidation with enhanced thick-walled hypodense collection associated with a 6 cm abscess (necrotizing pneumonia) and pleural effusion. Saccular lesion, measuring 14 mm, associated with mucormycotic pseudoaneurysm. C) Diagnostic-therapeutic arteriography. Saccular lesion associated with pseudoaneurysm in the lower branch of the medial segment of the RLL. D) Pseudoaneurysm appearing smaller than in Figure C, showing contrast extravasation associated with the rupture. E) Embolization by Amplatzer device (black arrow) and placement of coils (yellow arrow) in the arterial branch of the lower medial segment of the RLL. F) Surgical piece after right lower lobectomy, showing necrotic cavity and Amplatzer device (arrow).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AP: anteroposterior; RLL: right lower lobe; Rx: X-ray; CT: computed tomography.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 29-year-old patient who attended the emergency department due to generalized deterioration, dyspnea, fever of up to 38 °C, and right rib pain. She had recently been diagnosed with type I diabetes mellitus, with onset of an episode of ketoacidosis 1 week earlier. Clinical laboratory tests were significant for severe leukocytosis and hyperglycemia<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. Right lower lobe (RLL) pneumonia was identified (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) and the patient was hospitalized. The patient’s clinical progress was slow and she had an episode of self-limiting hemoptysis. Bronchoscopy was performed and a biopsy was obtained, identifying the presence of <span class="elsevierStyleItalic">Mucor</span> fungal hyphae. A contrast-enhanced chest computed tomography (CT) scan (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) revealed findings consistent with necrotizing pneumonia, increased pleural effusion, and a saccular lesion measuring 14 mm associated with a mucormycotic pseudoaneurysm of the lower medial segmental branch of the RLL.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In view of these findings, therapeutic arteriography (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C) with selective catheterization of the lesion was performed, causing it to rupture (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). The patient began to produce frank hemoptysis that required urgent embolization with a 14 mm Amplatzer II device and the placement of 10 mm coils and an 8 mm Amplatzer in the lower medial segmental branch of the RLL.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Following clinical stabilization with targeted treatment (amphotericin liposomal and capsofungin), a right lower lobectomy was performed in a second procedure (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>F) with no further complications.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This paper has not received any funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "Reference" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García Gallardo MdM, Berma Gascón ML. Diagnóstico y tratamiento urgente de la ruptura de un pseudoaneurisma mucormicótico pulmonar. Arch Bronconeumol. 2022;58:85.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 644 "Ancho" => 1000 "Tamanyo" => 94794 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Chest AP Rx showing alveolar infiltrate in RLL containing some radiolucent areas associated with pleural effusion. B) Contrast-enhanced chest CT (mediastinal window). Pulmonary parenchymal consolidation with enhanced thick-walled hypodense collection associated with a 6 cm abscess (necrotizing pneumonia) and pleural effusion. Saccular lesion, measuring 14 mm, associated with mucormycotic pseudoaneurysm. C) Diagnostic-therapeutic arteriography. Saccular lesion associated with pseudoaneurysm in the lower branch of the medial segment of the RLL. D) Pseudoaneurysm appearing smaller than in Figure C, showing contrast extravasation associated with the rupture. E) Embolization by Amplatzer device (black arrow) and placement of coils (yellow arrow) in the arterial branch of the lower medial segment of the RLL. F) Surgical piece after right lower lobectomy, showing necrotic cavity and Amplatzer device (arrow).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AP: anteroposterior; RLL: right lower lobe; Rx: X-ray; CT: computed tomography.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Reference" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathogenesis of mucormycosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.S. Ibrahim" 1 => "B. Spellberg" 2 => "T.J. Walsh" 3 => "D.P. Kontoyiannis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/cir865" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis." "fecha" => "2012" "volumen" => "54" "paginaInicial" => "S16" "paginaFinal" => "S22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22247441" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005800000001/v1_202201130549/S0300289621004063/v1_202201130549/en/main.assets" "Apartado" => array:4 [ "identificador" => "21422" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Clinical Images / Imágenes clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005800000001/v1_202201130549/S0300289621004063/v1_202201130549/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621004063?idApp=UINPBA00003Z" ]
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