Pulmonary Artery Pseudoaneurysms: Evaluation of Computed Tomography Angiography-based Vascular Mapping and Classification.

PURPOSE Vascular mapping and classification of pulmonary artery pseudoaneurysms (PAPs) using CTA to guide management. Correlation of CTA findings with DSA, considered the gold standard.

MATERIALS AND METHODS An ambispective study with 45 patients presenting with hemoptysis (2018-2023), diagnosed with PAP on CTA, was included in the study. PAPs were classified into 4 types based on CTA (type A: pure pulmonary artery supply, type B: dual supply from stenosed pulmonary and systemic artery branches, type C: bronchial/nonbronchial systemic supply, type D: depicted only on pulmonary CTA and not on DSA). Based on the CTA classification, PAPs were managed with pulmonary artery embolization (PAE), bronchial artery embolization (BAE), both or percutaneous embolization depending on supply, accessible location, and flow dynamics.

RESULTS In 45 patients, 54 PAPs were identified on CTA: type A (24), type B (4), type C (19), type D (7). Treatment included BAE (19 patients), PAE (8), both (11), and percutaneous embolization (7). The correlation of CTA with DSA based on classification type (type A: 100%, type B: 75%, type C: 89.4%) and based on predominant vascular supply (type A: 100%, type B: 75%, type C: 52.6%). All type D cases underwent percutaneous embolization.

CONCLUSION CTA shows excellent concordance with DSA for type A and B PAPs and moderate agreement for type C. It effectively guides targeted endovascular treatment, improving both technical and clinical success rates. In addition, CTA reduces unnecessary vessel cannulation and contrast exposure, aiding in the efficient management of moderate to massive hemoptysis.