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Chest clinic
Images in thorax
Pseudoaneurysm of the pulmonary artery with massive haemoptysis due to an invasive pulmonary mucormycosis
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  1. Alberto Lopez-Pastorini1,
  2. Aris Koryllos1,
  3. Michael Brockmann2,
  4. Wolfram Windisch3,
  5. Erich Stoelben1
  1. 1Department of Thoracic Surgery, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten-Herdecke University Hospital, Cologne, Germany
  2. 2Department of Pathology, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten-Herdecke University Hospital, Cologne, Germany
  3. 3Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten-Herdecke University Hospital, Cologne, Germany
  1. Correspondence to Dr Alberto Lopez-Pastorini, Department of Thoracic Surgery, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten-Herdecke University Hospital, Ostmerheimerstr. 200, Cologne D-51109, Germany; alberto.lopez{at}uni-wh.de

https://doi.org/10.1136/thoraxjnl-2015-207713

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    A 62-year-old man diagnosed with glioblastoma multiforme and currently under chemoradiation therapy presented with massive haemoptysis. Chest computed tomographic scan disclosed a round-shaped formation in the right upper lobe with contrast agent leakage indicating active bleeding (figure 1). Pathological examination after right upper lobectomy revealed a pseudoaneurysm of the pulmonary artery caused by invasive mucormycosis (figure 2).

    Figure 1
    Figure 1

    Contrast-enhanced computed tomography of the chest showing the pseudoaneurysm of the right upper lobe pulmonary artery. Image also demonstrates a contrast agent leakage indicating an active bleeding.

    Figure 2
    Figure 2

    Resected right upper lobe with pseudoaneurysm (arrows) of the pulmonary artery (A). B, bronchus; V, vein.

    After candidiasis and aspergillosis, mucormycosis is the third most frequent invasive mycosis in immunocompromised patients. In 25% the lungs are the main site of manifestation and in these cases a high mortality is reported.1 An interesting characteristic of Mucorales species is the angioinvasion which leads to rupture of vessels with massive haemorrhage.2

    References

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      . Mucormycosis: an emerging disease? Clin Microbiol Infec 2006;12:7–23. doi:10.1111/j.1469-0691.2006.01604.x
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      1. Lee FY,
      2. Mossad SB,
      3. Adal KA
      . Pulmonary mucormycosis: the last 30 years. Arch Intern Med 1999;159:1301–9. doi:10.1001/archinte.159.12.1301
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    Footnotes

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.