CTICasesBronchial Artery Pseudoaneurysm Rupture with Hemorrhage
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Imaging findings
The imaging shows a large right-sided pleural effusion with a sizable hematoma layering dependently within the fluid. A large, heterogeneous hematoma is also present within the lower-mid mediastinum. There are very dilated and tortuous bronchial arteries, predominantly around the left lower lobe main bronchus, with small collections matching blood pool density, confirmed as pseudoaneurysms. Post-coiling images reveal residual bronchocele and partially opacified dilatation of the bronchial artery. Extensive bronchiectasis and peribronchial opacification are noted, consistent with post-inflammatory/post-infectious changes.
Key takeaways
Chronic infection and inflammation can lead to hypertrophic bronchial arteries and, in rare instances, spontaneous rupture of pseudoaneurysms, resulting in extensive hemorrhage presenting as hemothorax and mediastinal hematoma. The underlying cause is often extensive bronchiectasis. While hypertrophied bronchial arteries are common in chronic inflammation, spontaneous pseudoaneurysm formation and rupture without prior surgery are unusual.
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