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An 11 year old girl with tetralogy of Fallot, who was initially palliated with a Waterston shunt and later underwent total correction, presented with bilateral branch pulmonary artery stenoses. She had two repeat balloon dilatations for residual pulmonary artery stenoses 24 and 32 months after corrective surgery. A 15 mm balloon was used to dilate the right pulmonary artery on both occasions. Although the right pulmonary artery was entered with difficulty using a superstiff wire, there was no untoward effect following dilatations.
Chest radiography showed a spherical shadow in the right lung when she was reviewed in the outpatients clinic four years after the procedure. She reported one episode of chest pain but no other symptoms before this finding.
Selective pulmonary angiography showed a large saccular false aneurysm attached to the right pulmonary artery with a wide pedicle. The lesion was thought to have occurred following the last dilatation procedure resulting from a small perforation in the right pulmonary artery.
Continuing expansion of the mass, compression to surrounding structures, infection, and in particular spontaneous rupture are among the most feared complications of false aneurysms. Surgery is therefore needed for most of these lesions. The patient is currently well and awaiting surgical resection of the false aneurysm.
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