Pulmonary artery aneurysm associated with sarcoidosis in a 75-year-old with heart failure: the challenges of diagnosis and management
  • Isabel Cruz
    Cardiology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
  • Rafaela Lopes
    Cardiology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
  • Bruno Bragança
    Cardiology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
  • Inês Campos
    Cardiology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
  • Inês Oliveira
  • Inês Gonçalves
    Cardiology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
  • Rui P. Santos
    Cardiology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
  • Aurora Andrade
    Cardiology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal

Keywords

Pulmonary artery aneurysm, sarcoidosis, pulmonary hypertension

Abstract

Introduction: Pulmonary artery aneurysm (PAA) is a rare abnormality of pulmonary vasculature. It can be idiopathic or secondary to various pathologies, frequently with multiple factors leading to its formation. We report the case of a man with concomitant sarcoidosis and PAA.
Case description: A 75-year-old male with a diagnosis of pulmonary sarcoidosis was referred to the Cardiology department due to heart failure with reduced left ventricular ejection fraction (LVEF). The transthoracic echocardiogram revealed mildly reduced LVEF, aortic root and pulmonary artery (PA) dilatation, and no signs of pulmonary hypertension (PH). Cardiac magnetic resonance imaging was performed, revealing mild left ventricular dilation, LVEF of 40%, main PA dilation (43 mm) and a pattern of late gadolinium enhancement suggestive of cardiac sarcoidosis. At follow-up, a thoracic computed tomography (CT) angiography scan revealed ascending aorta ectasia and giant main PA aneurysm (60 mm). A right heart catheterisation was performed, and a mean PA pressure of 34 mmHg was obtained. Given the clinical context, the patient was considered to have PH due to lung disease and left heart disease, and PAA was possible due to vascular granulomatous involvement by sarcoidosis.
Conclusion: PAA is a rare finding and mostly occurs in the setting of PH. Sarcoidosis is a granulomatous disease that mostly affects the lungs, but the sarcoid involvement of great vessels has been described. In this clinical case, the probable cause for the PA fragility leading to aneurysm formation remains sarcoid vascular infiltration, regarding the discrepancy between the PA dimensions and mildly elevated PA pressure.

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References

  • Gupta M, Agrawal A, Iakovou A, Cohen S, Shah R, Talwar A. Pulmonary artery aneurysm: a review. Pulm Circ 2020;10:2045894020908780.
  • Kreibich M, Siepe M, Kroll J, Höhn R, Grohmann J, Beyersdorf F. Aneurysms of the pulmonary artery. Circulation 2015;131:310–316.
  • Blankstein R, Stewart GC. Clinical manifestations and diagnosis of cardiac sarcoidosis [Internet]. Topic last updated: Dec 06, 2021. Available from: https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-cardiac-sarcoidosis
  • King TE, Culver DA. Extrapulmonary manifestations of sarcoidosis [Internet]. Topic last updated: Jan 11, 2024. Available from: https://www.uptodate.com/contents/extrapulmonary-manifestations-of-sarcoidosis
  • Hou R, Ma G-T, Liu X-R, Zhang C-J, Liu J-Z, Cao L-H, et al. Surgical treatment of pulmonary artery aneurysm: an institutional experience and literature review. Interact Cardiovasc Thorac Surg 2016;23:438–443.
  • Hritani AW, Samad F, Port SC, Tajik AJ. Massive pulmonary artery aneurysm. Circ Cardiovasc Imaging 2019;12:e008677.
  • King TE. Pathology and pathogenesis of sarcoidosis [Internet]. Topic last updated: Oct 22, 2021. Available from: https://www.uptodate.com/contents/pathology-and-pathogenesis-of-sarcoidosis
  • Uchida W, Tokuda Y, Mutsuga M, Usui A. Aortic sarcoidosis complicated by a pulmonary artery aneurysm. Eur J Cardiothoracic Surg 2018;54:786–788.
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    Published: 2024-02-09
    Issue: 2024: Vol 11 No 3 (view)


    How to cite:
    1.
    Cruz I, Lopes R, Bragança B, Campos I, Oliveira I, Gonçalves I, Santos RP, Andrade A. Pulmonary artery aneurysm associated with sarcoidosis in a 75-year-old with heart failure: the challenges of diagnosis and management. EJCRIM 2024;11 doi:10.12890/2024_004229.

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