Author + information
A twenty-year-old woman was admitted for patent arterial duct (PDA) ligation surgery in Oct 2014. She was hospitalized 8 months earlier due to high fever, cough, exertional dyspnea, staphylococcal aureus endocarditis, and received antibiotic treatment. In the recent admission, a grade 3/6 continuous murmur was heard at the left sternal border, and the other physical examination was normal.
An echocardiography showed a PDA in Feb 2014. In Oct 2014, an echo showed a 0.44cm width left-to-right PDA shunt, with peak velocity of 5.6m/s. A saccular main pulmonary artery aneurysm (PAA) was detected, with 3.8cm in width and 2.6cm in depth. It originated from the left side of the pulmonary trunk and 1.5cm above the pulmonary valve annulus. We identified the PDA jet flow unrestrictedly flowing into the aneurysm and swirling within it. The pulmonary artery computed tomographic angiography also revealed the aneurysm and drawn a similar conclusion as echo did.
The echocardiography played a vital role in evaluating the underlying pathology of PDA, invasive follow up, and making the diagnosis of PAA. The patient received a ligation of PDA, aneurysmectomy and the pulmonary artery wall repair surgery to avoid fatal rupture and hemorrhage.
Pulmonary artery aneurysm (PAA) is a rare lesion, which might be idiopathic or has several underlying pathologies.
Our case was an extremely rare PAA with PDA and secondary to infection. The high speed PDA shunt flow brought about weakness and injury of the arterial wall. The staphylococcal aureus infective process involving the arterial wall triggered ultimate formation of an aneurysm in the pulmonary artery trunk.
Echocardiography accurately determined the morphology, location of the proximal saccular PAA, and revealed the underlying pathology. It provided important information for a well-played surgical intervention to avoid fatal complications of PAA.