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Ruptured bronchial artery aneurysm associated with sarcoidosis

2003; Elsevier BV; Volume: 125; Issue: 5 Linguagem: Inglês

10.1067/mtc.2003.196

1097-685X

Hon Chi Suen, Charles C.D. DuMontier, John Boeren, Wayne Charland, Bill B. Daily,

Peptidase Inhibition and Analysis

A neurysms of the bronchial arteries are rare, but their causes are diverse. 1Bronchial artery aneurysms have never been described in association with sarcoidosis.We report the case of a 50-year-old woman with life-threatening rupture of a bronchial artery aneurysm associated with sarcoidosis. Clinical SummaryA 50-year-old woman who underwent an uneventful coronary artery bypass 6 months previously had a 2-day history of back pain, nausea, and malaise.Then she experienced severe dizziness and was brought to the emergency department.She was found to be pale.Her vital signs included blood pressure of 188/88 mm Hg, heart rate of 105 beats/min, and respiratory rate of 28 breaths/min.Breath sounds were absent over the left side of the chest.There was no cardiac murmur.Peripheral pulses were all palpable.Chest radiography showed that the left side of the chest was completely opacified, with the mediastinum deviated to the right.The hemoglobin level was only 4.5 g/dL.Left-sided hemothorax was diagnosed, and placement of a tube in the left side of the chest yielded 1400 mL of frank blood.She had a history of renal artery stenosis, with a baseline serum creatinine level of 1.7 mg/dL.Acute renal failure developed, superimposed on chronic renal failure, with a creatinine level increasing to 3.1 mg/dL.As a result, the emergency physician ordered a computed tomographic (CT) chest scan without intravenous contrast material.It revealed a massive left-sided hemothorax and a large subcarinal mediastinal mass.She was resuscitated and given a transfusion.Chest tube drainage had slowed, and the creatinine level decreased to 2 mg/dL.A CT chest scan with intravenous contrast material showed no evidence of aortic aneurysm or dissection, but there was a small globular vascular structure below the carina with extravasation (Figure 1).The chest was then surgically explored.Through a left thoracotomy through the fifth intercostal space, 2000 mL of blood clot was evacuated from the pleural cavity.A large mediastinal hematoma was identified between the heart and descending aorta, corresponding to the large subcarinal mass seen on the noncontrast CT scan.When the mediastinal hematoma was explored, many enlarged subcarinal and inferior pulmonary ligament lymph nodes were found, and pathologic examination revealed noncaseating granuloma consistent with sarcoidosis.Among the enlarged subcarinal lymph nodes, an actively bleeding 8-mm-diameter bronchial artery aneurysm was found.The feeding bronchial artery was ligated, and the aneurysm was excised.Pathologic examination confirmed a true aneurysm.Both staining and culture of the lymph nodes showed no evidence