Elsevier

American Heart Journal

Volume 34, Issue 4, October 1947, Pages 471-499
American Heart Journal

Original communication
Aneurysm of the pulmonary artery: Review of the literature and report of a case

https://doi.org/10.1016/0002-8703(47)90527-9Get rights and content

Abstract

An analysis has been presented of a series of thirty-six cases of aneurysm of the pulmonary artery, proved by necropsy and collected from the literature. The addition of this group to the 111 cases proved at necropsy and reported by Boyd and McGavack7 in 1939 brings the total number of authentic cases to 147. The advisability of omitting cases in which only the clinical diagnosis has been made is pointed out. The facts that the incidence according to sex is the same and that the patients concerned are relatively younger help to distinguish this type of aneurysm from that of the thoracic aorta. Although syphilis was a definite factor in more than a third of the cases, congenital cardiovascular anomalies also play a major role. A patient ductus arteriosus is present in more than 20 per cent of cases. Other less common causes are subacute bacterial endarteritis, atheroma, and trauma.

The early symptoms are dyspnea, cough, and pain in the thorax. Cyanosis and edema usually are later manifestations, often dependent on cardiac failure or congenital anomalies. The heart, especially the right ventricle, frequently is enlarged. Right axis deviation is common in the electrocardiogram. Most significant is the roentgenologic and roentgenoscopic finding of a discrete pulsatile hilar mass, separate from the aortic shadow. Usually, no special means of examination is necessary as a supplement to roentgenoscopy, although tomography, arteriography, roentgenokymography, and pneumomediastinum have been employed.

A detailed report of a case is presented. The condition of the patient was interesting in that the clinical diagnosis was confirmed by necropsy. There were a patent ductus arteriosus, atheroma of the right pulmonary artery, and bilateral pulmonary arteriolosclerosis, as well as a history of trauma. Surgical cure by ligation of the right pulmonary artery and pneumonectomy was prevented by the extent of the aneurysm and the atheromatous calcification of the vessel concerned.

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