背景:肺动脉假性动脉瘤(PAP)破裂引起的咯血是巨大而致命的,而导致假性动脉瘤破裂的因素仍然难以捉摸。本研究旨在阐明PAP的临床和放射学特征,并确定与破裂相关的危险因素。
方法:回顾性收集2019年1月至2022年12月发生PAP咯血的患者。人口统计学特征的临床数据,放射学发现,治疗策略,并收集预后。对破裂和未破裂病例的特征进行了比较分析。
结果:在50例患者中发现58例PAP。最常见的原因是感染(86%)和癌症(8%)。PAP主要位于双肺的上叶,57(99.3%)分布在节段或亚节段肺动脉中。中位直径为6.1(4.3-8.7)mm。共有29个PAP被确定为邻近肺空洞,腔的中值直径为18.9(12.4-34.8)mm。21例(42%)发生假性动脉瘤破裂。与未破裂组相比,破裂组大咯血的比例明显更高(57.1%vs.6.9%,p<0.001),较大的假性动脉瘤直径(8.1±3.2mmvs.6.0±2.3mm,p=0.012),肺空洞的发生率更高(76.2%vs.44.8%,p=0.027),和更大的空化直径(32.9±18.8mmvs.15.7±8.4mm,p=0.005)。破裂组的平均肺动脉压(mPAP)也明显高于未破裂组[23.9±7.4mmHgvs.19.2±5.0mmHg,p=0.011]。21例PAP破裂患者均成功行血管内治疗,其中临床成功率为96.0%。5例患者在一年内出现反复咯血。
结论:大咯血,假性动脉瘤直径,肺空洞,mPAP升高是假性动脉瘤破裂的危险因素。我们的发现有助于在破裂高风险下早期识别和及时干预PAP。
BACKGROUND: Hemoptysis resulting from
rupture of the pulmonary artery pseudoaneurysm (PAP) is massive and fatal, while factor contributing to the
rupture of pseudoaneurysm remains elusive. This study aimed to elucidate the clinical and radiological features of PAP and identify the risk factors associated with
rupture.
METHODS: Patients who developed hemoptysis with PAP were collected from January 2019 to December 2022 retrospectively. Clinical data of the demographic characteristics, radiological findings, treatment strategies, and prognosis were collected. A comparative analysis was performed on the characteristics in the ruptured and non-ruptured cases.
RESULTS: A total of 58 PAPs were identified in the 50 patients. The most common causes were infection (86%) and cancer (8%). The PAPs were located predominantly in the upper lobes of both lungs, and 57 (99.3%) were distributed in the segmental or subsegmental pulmonary arteries. The median diameter was 6.1(4.3-8.7) mm. A total of 29 PAPs were identified adjacent to pulmonary cavitations, with the median diameter of the cavity being 18.9 (12.4-34.8) mm.
Rupture of pseudoaneurysm occurred in 21 cases (42%). Compared to unruptured group, the ruptured group had a significantly higher proportion of massive hemoptysis (57.1% vs. 6.9%, p < 0.001), larger pseudoaneurysm diameter (8.1 ± 3.2 mm vs. 6.0 ± 2.3 mm, p = 0.012), higher incidence of pulmonary cavitation (76.2% vs. 44.8%, p = 0.027), and larger cavitation diameters (32.9 ± 18.8 mm vs. 15.7 ± 8.4 mm, p = 0.005). The mean pulmonary artery pressure (mPAP) in the ruptured group was also significantly higher than that in the unruptured group [23.9 ± 7.4 mmHg vs. 19.2 ± 5.0 mmHg, p = 0.011]. Endovascular treatment was successfully performed in all 21 patients with ruptured PAP, of which the clinical success rate was 96.0%. Five patients experienced recurrent hemoptysis within one year.
CONCLUSIONS: Massive hemoptysis, pseudoaneurysm diameter, pulmonary cavitation, and elevated mPAP were the risk factors for rupture of pseudoaneurysm. Our findings facilitate early identification and timely intervention of PAP at high risk of
rupture.