Endovascular Treatment of a Ruptured Pulmonary Artery Aneurysm in a Patient with Behçet's Disease Using the Amplatzer Vascular Plug 4
A 37-year-old man was admitted to our hospital with severe hemoptysis, and diagnosed with BD 5 years ago at another hospital. A small PAA had been treated by endovascular coil embolization and discharged with medical treatment consisting of prednisolone and cyclophosphamide which he had taken for only a few months.\nThe patient did not complain of fever or chills. In addition, his hemoglobin level was 11.1 g/dL and hematocrit was 35.3%. Pulse oximetry showed a moderate desaturation to 86% on room air.\nChest radiography showed an alveolar-type opacity in the left upper lobe. Because of worsening hemoptysis, urgent thoracic computed tomography (CT) scanning was performed before and after administration of 100 mL nonionic contrast material (Iomeron 350; Bracco, Milano, Italy) injected at 3.5 mL/sec through a 19-gauge peripheral intravenous catheter in the antecubital vein, with axial scanning from the lung apices to the diaphragm with a 4-section CT scanner (Somatom Sensation; Siemens Medical Solutions, Erlangen, Germany) (). CT images revealed a 27 × 19 mm aneurysm in the left upper lobe originating from the posterior segmental artery (Boyden A3), which was surrounded by an area of ground-glass opacity suggestive of vasculitis and hemorrhage ().\nWritten informed consent for embolization was obtained from the patient. After placement of a 5 Fr introducer sheath (Cordis, Miami, FL, USA) in the right femoral vein under local anesthesia, a diagnostic pulmonary angiography (Axiom Artis; Siemens Medical Solutions, Erlangen, Germany) confirmed the PAA in the left upper lobe (). The posterior segmental artery was approximately 5 mm in diameter at the aneurysm neck. A 4 Fr Cobra catheter (Tempo Aqua; Cordis Corporation, Miami, FL, USA) was introduced into the posterior segmental artery with the help of digital roadmapping and a 0.035-inch, 180-cm angled guidewire (Radifocus; Terumo, Tokyo, Japan). The PAA was embolized with an 8-mm AVP 4 (). Repeat angiography after embolization confirmed the occlusion of the aneurysm (). The patient did not have any further hemoptysis in the immediate post-embolization period, and his oxygen saturation progressively increased.\nChest radiography on day 3 after the embolization showed partial resolution of the left upper lobe alveolar-type opacity (), and the patient was discharged on day 4 with antibiotic prophylaxis and an immunosuppressive regimen.