Pulmonary Arterial Mycotic Pseudoaneurysms in a Patient with Invasive Pulmonary Aspergillosis: Successful Occlusion by Coils

摘要

A 77-year-old man was admitted for hemoptysis related to invasive pulmonary aspergillosis after chemotherapy for acute myeloid leukemia. Thoracic computed tomography scan disclosed bilateral pulmonary arterial mycotic pseudoaneurysms. He was previously treated with antifungal therapies for 28 days, including 8 days with a combination of voriconazole and caspofungin. The left aneurysm was treated first because of its large size (15 mm) by embolization with intrasaccular Cook coils (Bjaeverskov, Denmark), then the left smaller and the right one were treated similarly, 3 and 4 days later, respectively. Hemoptysis ceased for good after the second coil insertion. No recurrence occurred with further antifungal therapy. The patient died of a leukemia relapse 4 months later. Pulmonary arterial aneurysms may be causative of fatal hemoptysis by rupture of the wall of the feeding vessel (1-3). Endovascular occlusion by intrasaccular coils is effective and minimally invasive (4, 5) and should be now considered as the first-line treatment.