Pseudoaneurysm due to cancer is uncommon generally and is extremely rare in lung cancer. We report two cases of false aneurysms due to lung cancer that spontaneously regressed upon chemotherapy without intervention. Both patients had squamous cell carcinoma of the lung and the diagnosis of a pseudoaneurysm was made using computed tomography. There was no evidence of severe bronchial hemorrhage and the psuedoaneurysms were small and well-encased. Chemotherapy was performed and the pseudoaneurysms resolved.
Pseudoaneurysm formation in pulmonary vasculature is a rare condition that is more common in females and in the elderly (
A 71-year-old Korean male presented with blood-tinged sputum, cough, and dyspnea that had lasted for 1 month. He had been treated for diabetes mellitus, hypertension, and congestive heart failure until 2 years prior to presentation. The patient was a tobacco smoker (50 packs of cigarettes annually) and no history of previous respiratory disease, trauma, or pulmonary intervention. The general physical examination was unremarkable except for diminished breath sounds in the left hemithorax. Blood pressure was 120/70 mmHg, pulse rate was 80 beats/min, and respiratory rate was 20 breaths/min. Hemoglobin level was 11.3 g/dL and oxygen saturation was 92%. The ejection fraction was 57%. A chest radiograph showed atelectasis in the left lower lobe. A contrast-enhanced CT scan revealed a 5.5×4.2 cm mass at the level of the carina with enhancement of the central part of the mass, which was not visible on the pre-enhancement CT (
A 66-year-old Korean male presented with dyspnea and several episodes of minor hemoptysis lasting for 3 months. The patient was a tobacco smoker (70 packs of cigarettes annually) and had no significant medical history of trauma or pulmonary intervention. The physical examination was apparently normal. Blood pressure was 150/90 mmHg, pulse rate was 90 beats/min, and respiratory rate was 20 breaths/min. Hemoglobin level was 9.9 g/dL. A chest radiograph showed a diffuse and ill-defined patch of density in the right upper lobe. Contrast-enhanced CT in the arterial phase revealed a heterogeneously enhanced mass in the right upper lobe with a 1.4 cm sized lesion with strong enhancement in the center of the mass (
Pulmonary vasculature aneurysms and pseudoaneurysms are uncommon. Focal dilatation of the pulmonary artery can be congenital or acquired. Common causes include tuberculosis, pyogenic infection, trauma, and vasculitis (
In the past, the standard imaging technique for diagnosis of pseudoaneurym was pulmonary angiography, but this has now largely been superseded by CT angiography (
The treatment options for pseudoaneurysm include bronchoscopic coagulation, artery ligation, transcatheter embolization, lobectomy, and direct thrombin injection (
Spontaneous resolution of pseudoaneurysm is possible for small forms and in a low-pressure environment (
In our cases, the pseudoaneurysm was small and well-circumscribed without peripheral hemorrhage, and tightly encased within the cancer. Therefore, we reasoned that the pseudoaneurysm had less chance for rupture or massive hemorrhage. As the pseudoaneurysms resolved after chemotherapy, we pursued no further interventional procedures other than chemotherapy.
We have presented two cases of pseudoaneurysm associated with lung carcinoma. Our report is unique in that it is the first report in which pseudoaneurysm arising within lung cancer regressed in size following chemotherapy. Pulmonary circulation pseudoaneurysm should be considered in lung cancer cases with hemoptysis. But, if the patient has no massive hemoptysis and the pseudoaneurym is small in size, the patient should be carefully observed without interventional procedures. Further research is required to define the natural history and proper management for this medical condition.
This paper was supported by Wonkwang University in 2008.
CT observations for case 1. (A) Chest CT scan on admission demonstrated a central lung mass at the level of the carina, with no central enhancement within the mass in the pre-enhance CT. (B) A highly enhancing component within the mass was evident in the enhanced CT, similar in attenuation to that of the major vessels (black arrow).
Contrast-enhanced CT scan performed after the third cycle of combination chemotherapy of docetaxel and cisplatin for case 1. CT revealed a marked decrease in the size of the carinal lesion compared with an earlier study, and no central enhancing component.
CT observations for case 2. (A) Contrast-enhanced CT in the arterial phase revealed a heterogenous mass in the right upper lobe with a strongly enhancing 1.4 cm central area (black arrow). (B) The central enhancement was washed out in the delayed phase, compatible with a pseudoaneurysm of the artery.
Contrast-enhanced CT scan performed after the third cycle of combination chemotherapy of docetaxel and cisplatin for case 2. CT revealed significant decrease in the size of the mass and changed into a cavitary formation without central enhancement.