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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 83-year-old male with a history of atrioventricular block with a pacemaker presented with small-volume hemoptysis&#46; He had been hospitalized a week earlier with acute dyspnea on exertion and hypoxic respiratory failure&#44; diagnosed with bilateral pulmonary emboli&#46; He underwent suction thrombectomy using an Inari Flowtriever 24 catheter&#44; recovered well&#44; and was discharged on an oral anticoagulant&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient returned to the hospital a day after discharge with hemoptysis&#44; described as a quarter-sized dark red blood clot&#44; occurring about four days post-thrombectomy&#46; A computed tomography &#40;CT&#41; angiogram of the chest compared with the pre-thrombectomy CT chest &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; revealed a significant reduction in pulmonary arterial clot burden&#46; However&#44; a new finding was noted&#58; a heterogeneously hyperdense structure in the superior left lower lobe&#44; appearing connected to a left lower lobe segmental pulmonary artery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; These findings were consistent with a pulmonary artery pseudoaneurysm&#46; The patient underwent a pulmonary artery arteriogram&#44; which confirmed the presence of the pseudoaneurysm&#46; Following this confirmation&#44; coil embolization was performed&#44; with successful coiling verified fluoroscopically &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; After the procedure&#44; the patient did not experience any recurrent episodes of hemoptysis and recover well&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Pulmonary artery pseudoaneurysm &#40;PAP&#41; is a rare cause of hemoptysis&#44; involving only the outer layer of the vessel wall&#44; unlike true aneurysms which involve all three layers&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The risk of rupture in PAPs is generally correlated with their size&#44; with larger pseudoaneurysms carrying a higher risk&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> However&#44; given the overall high rupture potential&#44; prompt treatment is recommended regardless of size&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Untreated PAPs pose a significant threat&#44; as rupture can lead to massive hemoptysis with a high mortality rate&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">PAP typically presents with hemoptysis&#44; though shortness of breath may also occur&#44; either as a direct consequence of the PAP or secondary to hemoptysis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In some cases&#44; 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incidence of major adverse events&#44; including pulmonary vascular injury&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Prompt diagnosis via CT chest angiography in this case facilitated successful endovascular repair&#46; Surgical options for PAP repair include pneumonectomy&#44; lobectomy&#44; pulmonary artery ligation&#44; and direct arterial repair&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> but endovascular techniques such as transcatheter embolization offer a less invasive alternative with lower morbidity and mortality&#46; Despite the risks associated with transcatheter embolization&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> the patient underwent successful coil embolization without complications&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">This case highlights the clinical presentation and imaging findings of PAP&#44; a rare condition&#44; 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Clinical Letter
Pulmonary Artery Pseudoaneurysm: A Rare Complication After Suction Thrombectomy
Pseudoaneurisma de la arteria pulmonar: una complicación rara después de la trombectomía por succión
Madeline Watsona,b, Narat Srivalia,b,
Corresponding author
narat.srivali@duke.edu

Corresponding author.
a Department of Medicine (MW), Duke University, Durham, NC, USA
b Division of Pulmonary, Allergy, and Critical Care Medicine (NS), Duke University, Durham, NC, USA
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 83-year-old male with a history of atrioventricular block with a pacemaker presented with small-volume hemoptysis&#46; He had been hospitalized a week earlier with acute dyspnea on exertion and hypoxic respiratory failure&#44; diagnosed with bilateral pulmonary emboli&#46; He underwent suction thrombectomy using an Inari Flowtriever 24 catheter&#44; recovered well&#44; and was discharged on an oral anticoagulant&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient returned to the hospital a day after discharge with hemoptysis&#44; described as a quarter-sized dark red blood clot&#44; occurring about four days post-thrombectomy&#46; A computed tomography &#40;CT&#41; angiogram of the chest compared with the pre-thrombectomy CT chest &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; revealed a significant reduction in pulmonary arterial clot burden&#46; However&#44; a new finding was noted&#58; a heterogeneously hyperdense structure in the superior left lower lobe&#44; appearing connected to a left lower lobe segmental pulmonary artery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; These findings were consistent with a pulmonary artery pseudoaneurysm&#46; The patient underwent a pulmonary artery arteriogram&#44; which confirmed the presence of the pseudoaneurysm&#46; Following this confirmation&#44; coil embolization was performed&#44; with successful coiling verified fluoroscopically &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; After the procedure&#44; the patient did not experience any recurrent episodes of hemoptysis and recover well&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Pulmonary artery pseudoaneurysm &#40;PAP&#41; is a rare cause of hemoptysis&#44; involving only the outer layer of the vessel wall&#44; unlike true aneurysms which involve all three layers&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The risk of rupture in PAPs is generally correlated with their size&#44; with larger pseudoaneurysms carrying a higher risk&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> However&#44; given the overall high rupture potential&#44; prompt treatment is recommended regardless of size&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Untreated PAPs pose a significant threat&#44; as rupture can lead to massive hemoptysis with a high mortality rate&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">PAP typically presents with hemoptysis&#44; though shortness of breath may also occur&#44; either as a direct consequence of the PAP or secondary to hemoptysis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In some cases&#44; however&#44; PAP may be asymptomatic&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;3</span></a> Primary causes include infection&#44; malignancy&#44; and trauma&#44; often iatrogenic&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> PAP has been documented as rare complications of various interventional procedures&#44; including Swan-Ganz catheterization&#44; right heart catheterization&#44; biopsies&#44; chest tube insertion<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and also mechanical thrombectomy&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> This case represents the first known occurrence following suction thrombectomy using the Inari Flowtriever system&#46; The FLARE study<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> evaluating the Flowtriever system for percutaneous mechanical thrombectomy reported a less than 4&#37; incidence of major adverse events&#44; including pulmonary vascular injury&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Prompt diagnosis via CT chest angiography in this case facilitated successful endovascular repair&#46; Surgical options for PAP repair include pneumonectomy&#44; lobectomy&#44; pulmonary artery ligation&#44; and direct arterial repair&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> but endovascular techniques such as transcatheter embolization offer a less invasive alternative with lower morbidity and mortality&#46; Despite the risks associated with transcatheter embolization&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> the patient underwent successful coil embolization without complications&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">This case highlights the clinical presentation and imaging findings of PAP&#44; a rare condition&#44; and underscores a novel complication following suction thrombectomy for pulmonary emboli&#46; It emphasizes the importance of a multidisciplinary approach&#44; involving diagnostic radiology&#44; pulmonology&#44; and interventional radiology&#44; to ensure timely recognition and treatment of PAP&#44; ultimately improving patient outcomes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None for all authors&#46;</p></span></span>"
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ISSN: 03002896
Original language: English
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