Letter to the Editor
Spontaneous Regression of an Infectious Pulmonary Artery Pseudoaneurysm
Regresión espontánea de un pseudoaneurisma infeccioso de la arteria pulmonar
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Note also the relationship of the feeding vessel (arrowheads) to the pulmonary artery pseudoaneurysm (PAP; arrow). (B) Three-dimensional coronal reconstruction clearly depicts the PAP (arrow) and feeding vessel (arrowheads). (C) Pulmonary angiography performed 1 week after CT shows oligemia in the right upper lobe, with no opacification of the feeding vessel or PAP. A follow-up CT pulmonary angiography (D) demonstrated complete occlusion of the vessel and PAP, and partial resolution of the cavity.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Stéfanos Generalis, Renato Gonçalves de Mendonça, Edson Marchiori" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Stéfanos" "apellidos" => "Generalis" ] 1 => array:2 [ "nombre" => "Renato" "apellidos" => "Gonçalves de Mendonça" ] 2 => array:2 [ "nombre" => "Edson" "apellidos" => "Marchiori" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212918302179" "doi" => "10.1016/j.arbr.2018.02.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918302179?idApp=UINPBA00003Z" ] ] "EPUB" => 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array:2 [ "paginaInicial" => "400" "paginaFinal" => "401" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Linfoma pleural asociado a empiema crónico" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 988 "Ancho" => 3000 "Tamanyo" => 333132 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT with contrast medium, axial (left) and coronal slices (center and right): pleural mass in the medial portion of the anterior left chest wall with pericardial infiltration (solid arrows), and a large collection in the left hemithorax, corresponding with chronic pyothorax (dotted arrows), together causing contralateral mediastinal shift and cardiac compression.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Cerezo-Hernández, María Victoria García-Gallardo Sanz, Carmen Ainhoa Arroyo Domingo, Félix del Campo Matías" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ana" "apellidos" => "Cerezo-Hernández" ] 1 => array:2 [ "nombre" => "María Victoria" "apellidos" => "García-Gallardo Sanz" ] 2 => array:2 [ "nombre" => "Carmen Ainhoa" "apellidos" => "Arroyo Domingo" ] 3 => array:2 [ "nombre" => "Félix" "apellidos" => "del Campo Matías" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289618300127" "doi" => "10.1016/j.arbres.2017.12.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289618300127?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918301551?idApp=UINPBA00003Z" "url" => "/15792129/0000005400000007/v1_201807020412/S1579212918301551/v1_201807020412/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Spontaneous Regression of an Infectious Pulmonary Artery Pseudoaneurysm" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "402" "paginaFinal" => "403" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Stéfanos Generalis, Renato Gonçalves de Mendonça, Edson Marchiori" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Stéfanos" "apellidos" => "Generalis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Renato" "apellidos" => "Gonçalves de Mendonça" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Edson" "apellidos" => "Marchiori" "email" => array:1 [ 0 => "edmarchiori@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto D’Or para Pesquisa e Educação, Rio de Janeiro, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Regresión espontánea de un pseudoaneurisma infeccioso de la arteria pulmonar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1667 "Ancho" => 1667 "Tamanyo" => 384299 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Computed tomography (CT) pulmonary angiography (reconstruction with maximum intensity projection) showing a cavitated consolidation in the right upper lobe, with a highly enhancing nodule inside the cavity (arrow). Note also the relationship of the feeding vessel (arrowheads) to the pulmonary artery pseudoaneurysm (PAP; arrow). (B) Three-dimensional coronal reconstruction clearly depicts the PAP (arrow) and feeding vessel (arrowheads). (C) Pulmonary angiography performed 1 week after CT shows oligemia in the right upper lobe, with no opacification of the feeding vessel or PAP. A follow-up CT pulmonary angiography (D) demonstrated complete occlusion of the vessel and PAP, and partial resolution of the cavity.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the well-written scientific letter by Hamada et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> who reported the case of a 79-year-old man presenting a large lung abscess associated with a pulmonary artery pseudoaneurysm (PAP). He was treated by embolization of the pulmonary artery and showed complete resolution of the PAP and abscess in follow-up examinations. We would like to report the case of a 52-year-old man who presented to the emergency department with a 30-day history of fever, malaise, and weight loss. He also reported episodes of hemoptysis. A chest X-ray showed consolidation in the right upper lobe associated with cavitation and an air-fluid level. Contrast-enhanced chest computed tomography revealed extensive necrotic consolidation and a contrast-enhanced nodule inside the consolidation, related to a peripheral pulmonary artery (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B), suggesting the diagnosis of PAP. The patient's sputum was negative for acid-fast bacilli. He was referred for fiberoptic bronchoscopy with bronchoalveolar lavage. Cultures were negative for tuberculosis, but positive for <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>. Treatment with intravenous antibiotics (ceftriaxone) was implemented, and the patient responded to therapy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">However, a new expressive episode of hemoptysis led to a more aggressive approach, and a catheter angiogram with embolization was performed 1 week later. On angiography, the feeding vessel did not enhance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C), and selective catheterization was impossible. Bronchial and collateral angiography was also negative, suggesting thrombosis of the feeding vessel and PAP. The patient was discharged after computed tomography pulmonary angiography (CTPA) demonstrated complete occlusion of the vessel and PAP, and partial resolution of the cavity (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). The patient recovered uneventfully, with no evidence of bleeding during 1 year of follow-up.</p><p id="par0015" class="elsevierStylePara elsevierViewall">PAP is a rare and potentially life-threatening condition, with mortality rates of up to 50%. About one-third of PAP cases have infectious causes. Other important causes are direct trauma and neoplasms. Commonly cited pathogenic organisms include pyogenic bacteria, <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>, and fungi. Although some authors have cited <span class="elsevierStyleItalic">Klebsiella</span> sp. as a causal agent of PAP, we found no paper presenting actual cases in which these bacteria caused PAP. Hemoptysis is the most common presenting symptom. Nevertheless, PAP is often underdiagnosed, even in hemoptysis settings, as most PAPs are small (about 1<span class="elsevierStyleHsp" style=""></span>cm) and they may not be present in the acute phase of pulmonary abscess.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">CTPA with multiplanar reconstruction is the most important method for the diagnosis of PAP and its underlying cause. PAP can be identified as avidly enhancing nodules located in the walls of cavities or consolidations. Catheter angiography has been widely replaced by CTPA, being reserved for when intervention is planned. With catheter angiography, study of both the pulmonary and systemic circulations of the thorax is important.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–5</span></a> Hamada et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> commented that although most cases of PAP are treated with pulmonary artery embolization or surgical resection, spontaneous regression and resolution with antibiotic therapy have been documented in the literature. Our patient showed spontaneous resolution of the PAP after the clinical treatment of pneumonia. In conclusion, PAP should be included in the differential diagnosis of hemoptysis in patients with pulmonary infection.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1667 "Ancho" => 1667 "Tamanyo" => 384299 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Computed tomography (CT) pulmonary angiography (reconstruction with maximum intensity projection) showing a cavitated consolidation in the right upper lobe, with a highly enhancing nodule inside the cavity (arrow). Note also the relationship of the feeding vessel (arrowheads) to the pulmonary artery pseudoaneurysm (PAP; arrow). (B) Three-dimensional coronal reconstruction clearly depicts the PAP (arrow) and feeding vessel (arrowheads). (C) Pulmonary angiography performed 1 week after CT shows oligemia in the right upper lobe, with no opacification of the feeding vessel or PAP. A follow-up CT pulmonary angiography (D) demonstrated complete occlusion of the vessel and PAP, and partial resolution of the cavity.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Large lung abscess with pulmonary artery pseudoaneurysm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Hamada" 1 => "A. Nakano" 2 => "M. 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Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.10091416" "Revista" => array:7 [ "tituloSerie" => "Radiology" "fecha" => "2010" "volumen" => "256" "paginaInicial" => "656" "paginaFinal" => "664" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20656846" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0026049517300471" "estado" => "S300" "issn" => "00260495" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemoptysis in tuberculosis: the importance of contrast-enhanced computed tomography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.D. Grando" 1 => "G. Zanetti" 2 => "E. Marchiori" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2015.09.006" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2016" "volumen" => "52" "paginaInicial" => "173" "paginaFinal" => "174" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26518656" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005400000007/v1_201807020412/S1579212918302179/v1_201807020412/en/main.assets" "Apartado" => array:4 [ "identificador" => "49862" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005400000007/v1_201807020412/S1579212918302179/v1_201807020412/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918302179?idApp=UINPBA00003Z" ]
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