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Ann Thorac Surg 1995;59:530
© 1995 The Society of Thoracic Surgeons

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Invited Commentary

Invited Commentary

Department of General Thoracic Surgery Massachusetts General Hospital Boston, MA 02114

See also page 528.

The literature on the subject of peripheral pulmonary artery aneurysms is both scant and confusing. This case is only the second true peripheral aneurysm reported in the English-language surgical literature since our article 20 years ago [1]. The confusion stems from the exact definition of the adjective ``peripheral''; in other words, at what level of the pulmonary artery branching does an aneurysm become peripheral? The level should be described accurately, ie, lobar or segmental. Aneurysms of the main pulmonary artery or pulmonary trunk are central.

The remarkable feature of this case report was the successful treatment of the aneurysm once it had eroded into an adjacent bronchus. In our review of the literature [1], 21 of 35 patients (60%) with solitary peripheral pulmonary artery aneurysm died of its rupture. When the diagnosis is established before rupture, a lesser resection of pulmonary parenchyma is usually possible. The hemorrhage into lung tissue in this case made it obligatory to resect the entire left lower lobe.

A final comment deals with etiology. None of the usual factors was present in this case: congenital heart disease, pulmonary hypertension, trauma, or infection. As in our case, there were pathologic changes within the media of the arterial wall at the site of the aneurysm. It is my opinion now that this is insufficient evidence on which to base the claim that the aneurysm is congenital in origin. Idiopathic seems more appropriate.

Reference

1. Monchik J, Wilkins EW Jr. Solitary aneurysm of the middle lobe artery: a case report and review of solitary peripheral pulmonary artery aneurysms. Ann Thorac Surg 1974;17:496–503.[Medline]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Earle W. Wilkins, Jr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wilkins, E. W. Search for Related Content PubMed Articles by Wilkins, E. W., Jr Related Collections Related Article