case_images: PMC7771397_01
case_images: A 46-year-old male presented with chest pain for 1 month. Frontal chest radiograph shows a homogenous radio-opacity in the left upper zone, broad based toward aortic knuckle (large white arrow) causing superior mediastinal widening.
case_images: JCIS-10-86-g001.jpg
case_images: PMC7771397_01_JCIS-10-86-g001.jpg
case_images: F1
case_images: The radio-opacity is broad based toward the superior mediastinum with a widening of the same [Figure 1].
case_images: (a-c) A 46-year-old male presented with chest pain for 1 month. Multidetector computed tomography thoracic aortography (axial, sagittal, and coronal sections in mediastinal window) shows focal intense enhancing saccular outpouching (pseudoaneurysm) in the inferolateral wall of aortic isthmus, mushroom shaped (*) just distal to origin of the left subclavian artery (small white arrow) with periaortic hypoattenuating prominent inflammatory soft tissue (large white arrow) causing subsegmental passive collapse of the left upper lobe (white arrowhead).
case_images: JCIS-10-86-g002.jpg
case_images: PMC7771397_01_JCIS-10-86-g002.jpg
case_images: F2
case_images: Multidetector computed tomography (MDCT) thoracic aortography was done, which showed focally intense enhancing saccular outpouching in the inferolateral wall of aortic isthmus, mushroom shaped [Figure 2a-c] and presented just distal to the origin of the left subclavian artery [Figure 2a-c]. This measures ~46 x 27 x 42 mm (AP x TR x CC) and 14 mm (neck) with prominent periaortic hypoattenuating inflammatory soft tissue causing a subsegmental passive collapse of the left upper lobe [Figure 2a-c].
case_images: (a) A 46-year-old male presented with chest pain for 1 month. Multidetector computed tomography (MDCT) thoracic aortography - three-dimensional (3D) volume rendered (VR) image (axial) shows focal saccular outpouching (pseudoaneurysm) in the inferolateral wall of aortic isthmus, mushroom shaped (white arrow) just distal to origin of the left subclavian artery. (b) A 46-year-old male presented with chest pain for 1 month. MDCT thoracic aortography - 3D VR image (sagittal) shows focal saccular outpouching (pseudoaneurysm) in the inferolateral wall of aortic isthmus, mushroom shaped (large white arrow) just distal to origin of the left subclavian artery (small white arrow). (c) A 46-year-old male presented with chest pain for 1 month. MDCT thoracic aortography - 3D multidetector computed tomography image (coronal) shows focal saccular outpouching (pseudoaneurysm) in the inferolateral wall of aortic isthmus, mushroom shaped (large white arrow) just distal to origin of the left subclavian artery (small white arrow).
case_images: JCIS-10-86-g003.jpg
case_images: PMC7771397_01_JCIS-10-86-g003.jpg
case_images: F3
case_images: (a and b) A 46-year-old male presented with chest pain for 1 month. Multidetector computed tomography thoracic aortography, (axial sections in mediastinal window) shows few para-aortic necrotic lymph nodes (white arrowhead), few left lower paratracheal partially necrotic lymph nodes (small white arrow), and few aortopulmonary or subaortic partially necrotic lymph nodes (large white arrow).
case_images: JCIS-10-86-g004.jpg
case_images: PMC7771397_01_JCIS-10-86-g004.jpg
case_images: F4
case_images: Few para-aortic necrotic lymph nodes were seen; the largest of these measures 17 x 11 mm in station 6 [Figure 4a]. Few left lower paratracheal partially necrotic lymph nodes were seen; the largest of these measures 14 x 10 mm in station 4L [Figure 4b]. Few aortopulmonary or subaortic partially necrotic lymph nodes were seen, the largest of these measures 15 x 11 mm in station 5 [Figure 4b], signifying reactive lymphadenopathy.
case_images: PMC7771397_02
case_images: A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. Frontal chest radiograph shows a fairly defined inhomogeneous radio-opacity in the right upper and mid zones lung fields (large white arrow).
case_images: JCIS-10-86-g005.jpg
case_images: PMC7771397_02_JCIS-10-86-g005.jpg
case_images: F5
case_images: (a-d) A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. Multidetector computed tomography pulmonary arteriography (axial sections in mediastinal and lung windows) and (coronal sections in mediastinal and lung windows) shows focal intensely enhancing saccular outpouching (pseudoaneurysm) arising from the feeding posterior segmental branch of the right pulmonary artery (large white arrow) supplying the upper lobe with large inhomogeneous mass with extensive internal air bronchograms, internal reticulations, and cavitations (small white arrow).
case_images: JCIS-10-86-g006.jpg
case_images: PMC7771397_02_JCIS-10-86-g006.jpg
case_images: F6
case_images: MDCT pulmonary arteriography was done, which showed a well-defined intensely enhancing saccular outpouching measuring 1.8 x 1.5 x 1.5 cm (CC x AP x TR), arising from the feeding posterior segmental branch of the right pulmonary artery, supplying the upper lobe [Figure 6a-d]. Large inhomogeneous mass with extensive air bronchograms, internal reticulations, cavitations, perifocal ground-glass opacities, and septal thickenings was seen [Figure 6b and d].
case_images: (a) A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. Multidetector computed tomography (MDCT) pulmonary arteriography - three-dimensional (3D) volume rendered (VR) image (axial) shows focal saccular outpouching (pseudoaneurysm) arising from the feeding posterior segmental branch of the right pulmonary artery (white arrow). (b) A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. MDCT pulmonary arteriography - 3D VR image (coronal) shows focal saccular outpouching (pseudoaneurysm) arising from the feeding posterior segmental branch of the right pulmonary artery (white arrow). (c) A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. MDCT pulmonary arteriography - 3D VR image (sagittal) shows focal saccular outpouching (pseudoaneurysm) arising from the feeding posterior segmental branch of the right pulmonary artery (white arrow).
case_images: JCIS-10-86-g007.jpg
case_images: PMC7771397_02_JCIS-10-86-g007.jpg
case_images: F7
case_images: (a) A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. Immediate postoperative follow-up frontal chest radiograph shows coils filling the pseudoaneurysm sac (small white arrow) with minimal resolution of inhomogeneous radio-opacity (white arrowhead). (b) A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. Post-operative day 3 follow-up frontal chest radiograph shows coils filling the pseudoaneurysm sac (small white arrow) with partial resolution of inhomogeneous radio-opacity (white arrowhead). (c) A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. Four weeks post-operative follow-up frontal chest radiograph shows coils filling the pseudoaneurysm sac (small white arrow) with near-complete resolution of inhomogeneous radio-opacity (white arrowhead).
case_images: JCIS-10-86-g008.jpg
case_images: PMC7771397_02_JCIS-10-86-g008.jpg
case_images: F8
case_images: Post-operative follow-up chest radiographs (immediate, 3 days later, and 4 weeks later) were taken, which showed coiling with minimal, partial, and near-complete resolution of the inhomogeneous radio-opacity, respectively [Figure 8a-c].
case_images: PMC7771397_03
case_images: A 43-year-old male presented fever, pain, and localized swelling in the right upper anterior chest wall for 1 month. Frontal chest radiograph shows no significant abnormality.
case_images: JCIS-10-86-g009.jpg
case_images: PMC7771397_03_JCIS-10-86-g009.jpg
case_images: F9
case_images: (a-c) A 43-year-old male presented fever, pain, and localized swelling in the right upper anterior chest wall for 1 month. Contrast-enhanced computed tomography chest (axial, coronal, and sagittal sections in mediastinal window) shows a fairly defined peripherally enhancing collection in the right upper anterior chest wall epicentered in 1st costochondral junction and sternocostal joint (small white arrow). Adjacent encasement of the right internal mammary artery with pseudoaneurysm of the artery is seen (large white arrow).
case_images: JCIS-10-86-g010.jpg
case_images: PMC7771397_03_JCIS-10-86-g010.jpg
case_images: F10
case_images: CT chest showed a soft-tissue density lesion/ fluid collection measuring ~5.4 x 4 x 3.9 cm in the right upper anterior chest wall, epicenter in the first costochondral junction, and sternocostal joint causing bony destruction and lysis of the right costochondral junction. Contrast-enhanced CT chest showed the central non-enhancing necrotic area with faintly enhancing thin septations and peripheral faintly enhancing margin [Figure 10a-c]. These features represent the infective collection with pseudoaneurysm of the right internal mammary artery [Figure 10a-c].
case_images: (a) A 43-year-old male presented fever, pain, and localized swelling in the right upper anterior chest wall for 1 month. Contrast-enhanced computed tomography (CT) chest - three-dimensional (3D) volume rendered (VR) image (axial) shows focal saccular outpouching (pseudoaneurysm) of the right internal mammary artery (large white arrow). (b) A 43-year-old male presented fever, pain, and localized swelling in the right upper anterior chest wall for 1 month. Contrast-enhanced CT chest - 3D VR image (coronal) shows focal saccular outpouching (pseudoaneurysm) of the right internal mammary artery (large white arrow). (c) A 43-year-old male presented fever, pain, and localized swelling in the right upper anterior chest wall for 1 month. Contrast-enhanced CT chest - 3D VR image (sagittal) shows focal saccular outpouching (pseudoaneurysm) of the right internal mammary artery (large white arrow).
case_images: JCIS-10-86-g011.jpg
case_images: PMC7771397_03_JCIS-10-86-g011.jpg
case_images: F11