CTICasesNecrotizing Pneumonia with Pseudoaneurysm Rupture
Imaging findings
Chest CT shows necrotizing right lower lobe Streptococcus anginosus pneumonia and a large pleural effusion. Follow-up CT after TPA/DNase instillation demonstrates rapid whiteout due to a ruptured subsegmental pulmonary artery pseudoaneurysm, causing massive hemoptysis and hemothorax. Selective angiogram confirmed the pseudoaneurysm, which was coiled.
Key takeaways
Necrotizing pulmonary infections can erode adjacent pulmonary arteries, forming mycotic/necrotizing pseudoaneurysms. These can rupture catastrophically, presenting as massive hemoptysis and acute hemothorax.
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