Pulmonary artery pseudoaneurysm- A rare vascular catastrophe in pulmonary mucormycosis in a post covid patient .
Y. Sivagnaname*a (Dr), P. Radhakrishnana (Dr), A. Maria Selvama (Dr)
a Sri Manakula vinayagar Medical college and hospital, Puducherry, INDIA
* nsivagnaname@yahoo.com
Background:
Pulmonary artery pseudo aneurysm(PAP) in Pulmonary mucormycosis is a rare clinical entity sparsely reported in literature.Moreover PAP presenting as Endobronchial mass with hemoptysis is a real eye opener for clinicians to consider as differential diagnosis and to avoid bronchoscopic biopsies when they see a mass in diagnostic bronchoscopy. We encountered 3 similar cases which was diagnosed early and managed well because of our initial experience .
Case Report:
48 year old female came to our hospital with chief complaints of cough with blood tinged sputum for 1 month and breathlessness for 1 month.Patient had severe covid pneumonia 1 month back admitted in a covid care hospital and was discharged.She is a known case of systemic Hypertension and Diabetes under treatment for 5 years.Complete blood count showed neutrophilic leucocytosis with uncontrolled Diabetes mellitus (Fasting blood sugar 280mg/dl and Post prandial sugar 430mg/dl).Chest Radiograph and Non contrast computed tomography were suggestive of Right lower lobe consolidation.Sputum for Acid fast bacilli,Gram stain ,fungal direct smears/cultures were unyielding .Patient was then posted for diagnostic bronchoscopy which showed smooth globular mass arising from the bronchial wall completely occluding anterior and lateral basal segments,bleeds on coughing.Bronchoalveolar lavage smear and culture confirmed the diagnosis of mucor.In view of bronchoscopic findings ,CT pulmonary angiography was performed which showed pseudoaneurysm involving right descending pulmonary artery and posterior basal segmental artery.
Finally patient was diagnosed to have pulmonary mucormycosis with pulmonary artery pseudoaneurysm presented as endobronchial mass with hemoptysis.Patient was started on liposomal amphotericin along with other supportive measures and later referred to thoracic surgeon for surgical resection(Lobectomy).
Conclusion :
Pulmonary artery pseudoaneurysm in Pulmonary mucormycosis is a rare clinical entity with limited description in literature High clinical suspicion,early diagnosis and timely intervention can prevent morbidity and mortality.
Disclosure of funding source(s): none