CTICasesSystemic Collateral Hypertrophy and Pseudoaneurysm post Lobectomy
Imaging findings
CT chest post-left upper lobectomy shows a bronchopleural fistula, chronic empyema cavity, and a pseudoaneurysm. Angiography shows the pseudoaneurysm is fed by massively hypertrophied systemic collateral arteries arising from the subclavian artery (internal mammary, lateral thoracic).
Key takeaways
Chronic pleural infection (empyema) or bronchopleural fistula post-lobectomy can trigger severe localized inflammation, leading to recruitment and massive hypertrophy of adjacent systemic arteries (mammary/subclavian branches). These systemic collaterals can form pseudoaneurysms that require embolization.
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