J Korean Soc Radiol. 2011 Dec;65(6):573-576. Korean.
Published online Dec 31, 2011.
Copyright © 2011 The Korean Society of Radiology
Case Report

Endovascular Thrombin Injection for a Pulmonary Artery Pseudoaneurysm: Case Report

Jin Ho Shin, MD, Ji Hoon Shin, MD, and Hyun Ki Yoon, MD
    • Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Received August 11, 2011; Accepted September 06, 2011.

Abstract

Massive hemoptysis caused by pulmonary artery pseudoaneurysms is uncommon, and endovascular treatment such as coil embolization is the first choice for treating pulmonary artery pseudoaneurysms. Various embolic agents could be used according to the angiographic findings, yet embolization with thrombin injection is very rare. Herein, we describe a case of a pulmonary artery pseudoaneurysm that was successfully treated by endovascular thrombin injection using a microcatheter because of the difficulty in performing a coil embolization due to a short feeding artery.

Keywords
Pulmonary Artery Pseudoaneurysm; Thrombin; Embolization; Therapeutic

Figures

Fig. 1
A 72-year-old woman with pulmonary artery pseudoaneurysm.
A. A contrast-enhanced chest CT scan shows a small enhancing lesion within the consolidative right middle lung (arrow).

B, C. Axial and coronal CT images obtained at 2 weeks follow-up show a markedly enlarged enhancing lesion at the origin of right pulmonary artery (arrows).

D. Selective right pulmonary angiogram demonstrates approximately 2 cm pseudoaneurysm with a main draining vein.

E. A main draining vein was embolized with two microcoils, then 1,000 IU thrombin was injected.

F. Final pulmonary angiogram shows no visualization of the pseudoaneurysm.

G. Follow-up CT 1 month after the procedure shows coils in the draining vein, with disappearance of pseudoaneurysm.

References

    1. Sbano H, Mitchell AW, Ind PW, Jackson JE. Peripheral pulmonary artery pseudoaneurysms and massive hemoptysis. AJR Am J Roentgenol 2005;184:1253–1259.
    1. Hovis CL, Zeni PT Jr. Percutaneous thrombin injection of a pulmonary artery pseudoaneurysm refractory to coil embolization. J Vasc Interv Radiol 2006;17:1943–1946.
    1. Lee K, Shin T, Choi J, Kim Y. Percutaneous injection therapy for a peripheral pulmonary artery pseudoaneurysm after failed transcatheter coil embolization. Cardiovasc Intervent Radiol 2008;31:1038–1041.
    1. Schellhammer F, Steinhaus D, Cohnen M, Hoppe J, Mödder U, Fürst G. Minimally invasive therapy of pseudoaneurysms of the trunk: application of thrombin. Cardiovasc Intervent Radiol 2008;31:535–541.
    1. Dobies DR, Cohoon AL, Bates AA. Images in cardiovascular medicine. Repair of a perforated pulmonary artery due to a Swan-Ganz catheter using thrombin injection. Circulation 2009;119:e521–e522.
    1. Cope C, Zeit R. Coagulation of aneurysms by direct percutaneous thrombin injection. AJR Am J Roentgenol 1986;147:383–387.
    1. Remy J, Lemaitre L, Lafitte JJ, Vilain MO, Saint Michel J, Steenhouwer F. Massive hemoptysis of pulmonary arterial origin: diagnosis and treatment. AJR Am J Roentgenol 1984;143:963–969.
    1. Keeling AN, Costello R, Lee MJ. Rasmussen's aneurysm: a forgotten entity? Cardiovasc Intervent Radiol 2008;31:196–200.
    1. Krueger K, Zaehringer M, Strohe D, Stuetzer H, Boecker J, Lackner K. Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients. Radiology 2005;236:1104–1110.
    1. Vázquez V, Reus M, Piñero A, Abellán D, Canteras M, Espinosa de Rueda M, et al. Human thrombin for treatment of pseudoaneurysms: comparison of bovine and human thrombin sonogram-guided injection. AJR Am J Roentgenol 2005;184:1665–1671.

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