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Images in Intensive Medicine
DOI: 10.1016/j.medin.2021.01.006
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Available online 9 March 2021
Massive hemoptysis due to Aspergillus-related pulmonary artery pseudoaneurysm in a patient with COVID-19 pneumonia
Hemoptisis masiva debido a un pseudoaneurisma de la arteria pulmonar en una paciente con aspergilosis pulmonar y neumonía COVID-19
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I. Baezaa, I. Romeraa,
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irene.r.s@outlook.com

Corresponding author.
, J.R. Fortuñob
a Unidad de Cuidados Intensivos, SCIAS Hospital de Barcelona, Barcelona, Spain
b Departamento de Radiología, SCIAS Hospital de Barcelona, Barcelona, Spain
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A 70-year-old woman was admitted to our intensive care unit due to COVID-19 pneumonia. She received treatment with remdesivir for five days, two doses of tocilizumab and methylprednisolone (1mg/kg/day). Patient required intubation and tracheostomy due to myopathy. After nineteen days, patient presented a massive hemoptysis. An urgent bronchoscopy evidenced a non-occlusive clot in the right main bronchus and a pulsatile lesion underneath. The pulmonary artery angiography showed a pseudoaneurysm in a right intercostobronchial trunk (Fig. 1) with extravasation of iodinated contrast (red star). Immediate transcatheter exclusion of the pseudoaneurysm was successful. The thoracic CT-scan evidenced the typical COVID-19 pattern with a highly suspicious aspergillus cavity (red arrow) in the right upper lobe pulmonary parenchyma (Figs. 2 and 3). Respiratory secretions cultures were positive for Aspergillus niger so dual antifungal treatment was started. This case illustrates the risk of COVID-19 associated pulmonary aspergillosis (CAPA) and related complications.

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Funding

This work has not received any type of funding.

Conflicts of interest

The authors declare that they have no conflict of interest.

Copyright © 2021. Elsevier España, S.L.U. y SEMICYUC
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Medicina Intensiva (English Edition)

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