J Korean Soc Radiol.  2011 Dec;65(6):573-576. 10.3348/jksr.2011.65.6.573.

Endovascular Thrombin Injection for a Pulmonary Artery Pseudoaneurysm: Case Report

• Shin JH
• Shin JH
• Yoon HK

• KMID: 2002924
• DOI: http://doi.org/10.3348/jksr.2011.65.6.573

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.

MeSH Terms

Aneurysm, False
Arteries
Hemoptysis
Pulmonary Artery
Thrombin
Thrombin

Figure

• 

  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.

Reference

1. Sbano H, Mitchell AW, Ind PW, Jackson JE. Peripheral pulmonary artery pseudoaneurysms and massive hemoptysis. AJR Am J Roentgenol. 2005; 184:1253–1259.

2. 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.

3. 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.

4. 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.

5. 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.

6. Cope C, Zeit R. Coagulation of aneurysms by direct percutaneous thrombin injection. AJR Am J Roentgenol. 1986; 147:383–387.

7. 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.

8. Keeling AN, Costello R, Lee MJ. Rasmussen's aneurysm: a forgotten entity? Cardiovasc Intervent Radiol. 2008; 31:196–200.

9. 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.

10. 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.