CTICasesBilateral Pulmonary Artery Mycotic Aneurysms from Septic Embolism
Imaging findings
Contrast-enhanced chest CT in a 30-year-old intravenous drug user shows multiple peripheral wedge-shaped infarcts and nodules in both lungs. Over a two-week period, serial CT scans demonstrate progressive dilation of the lobar and segmental pulmonary arteries in both lower lobes, developing into large bilateral pulmonary artery mycotic aneurysms (pseudoaneurysms) containing central thromboemboli.
Key takeaways
Pulmonary artery mycotic aneurysms are rare, high-risk vascular lesions that typically develop secondary to endocarditis and septic pulmonary embolism, commonly due to Staphylococcus aureus. The infectious process destroys the arterial wall, leading to pseudoaneurysm formation. Because of a high risk of fatal rupture and hemoptysis, management requires prompt antibiotic therapy and frequently endovascular coiling or occlusion.
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