August Case of the Month

Access case here.

Authors: Allison M. Aripoli, MD,PGY-4, Radiology Resident, Department of Diagnostic Radiology, University of Kansas Medical Center, Kansas City, Kans.; Lucas Meek, MDPGY-5, Assistant Professor of Radiology, Cardiothoracic Imaging, Department of Diagnostic Radiology, University of Kansas Medical Center,Kansas City, Kans.; Steven Lemons, MD Associate Professor of Radiology,Assistant Professor of Radiology, Vascular and Interventional Radiology, Department of Interventional Radiology University of Kansas Medical Center, Kansas City, Kans.

Why did you select this case for submission?

Mycotic pulmonary artery pseudoaneurysms are uncommon, but an important entity to recognize because of the associated morbidity and mortality. This case was unique not only for its rarity, but also because we were able to follow the case from presentation through treatment.

What should readers learn from this case?

The clinical context for image interpretation of cavitary lung lesions is valuable. While cavitary pulmonary metastases, granulomatosis with polyangitis, and infection can cause cavitary lesions, in the setting of sepsis, septic pulmonary emboli should be considered. It is important to realize that pulmonary artery pseudoaneurysms can be caused by erosion of the vascular wall by neoplasms or infection.

What did you learn from working on the case?

This case gave me the opportunity to review causes of both cavitary lung lesions and pulmonary artery pseudoaneurysms. Because mycotic pulmonary artery aneurysms are uncommon, it was also a great opportunity to review existing literature regarding treatment options.

How did guidance from senior staff at your institution impact your learning and case development?

Senior staff interpreted this case independently, but shared the imaging findings to promote learning. I took the opportunity to review the imaging, clinical history, and available literature. When unique cases are encountered, imparting knowledge to trainees is invaluable.

Why did you choose Case in Point for submission of your case?

Case in Point is an excellent avenue to distribute cases amongst fellow radiology residents and radiologists. I have enjoyed many case learning opportunities through CIP, and wanted to share this rather uncommon case.

What is the appeal of online learning tools such as Case in Point as opposed to print learning venues?

Online learning in a case-based format with selected pertinent images is appealing for several reasons. First, accessing the cases is easy, especially when linked through email notification. Second, the question-type format highlighting differential diagnoses followed by a summary provides concise and directed learning. In addition, there is variety to daily cases, which is especially important for radiology trainees.

Are you a regular reader of Case in Point? What are your favorite types of cases?

Yes, and as a regular reader my favorite types of cases are the rare but important ones. CIP offers outstanding exposure to images of unusual cases encountered at various institutions. I also like the collection of uncommon presentations of common entities.

Is there anything else you'd like readers to know about your case?

The patient highlighted in this case had a very good clinical outcome following endovascular intervention, which is remarkable considering the reported mortality rate for patients with pulmonary artery pseudoaneurysm.

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