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A 56 year old woman was referred to our hospital with a 12 month history of exertional breathlessness. Auscultation revealed a soft ejection systolic murmur maximal at the left sternal edge. Electrocardiography and echocardiography were normal. Chest radiography revealed a well defined 1.5 cm diameter spherical mass adjacent to the left atrial appendage (left panel). Selective left pulmonary angiography confirmed a pulmonary artery aneurysm (PAA) arising from the lingular artery (right panel). The feeding artery was embolised with coils (Cook UK) and angiography confirmed successful exclusion of the aneurysm from the circulation.
PAAs are a rare abnormality. Deterling and Claggett noted the vascular anomaly in only eight of a series of 100 000 unselected necropsies and over 50% of cases were associated with congenital heart disease. Patients with PAA may be entirely asymptomatic or complain of symptoms, such as chest pain, cough, and breathlessness. Little is known about the natural history of PAAs; however, all aneurysms have the potential for rupture and it has been suggested that a third of patients with proximal PAA die from such a haemorrhage. We safely and effectively treated a peripheral anomaly with coil embolisation.
