Takeshi Sugahara
A 65-year-old woman with a 14-year history of hypertension and chronic renal failure secondary to an unknown disease was admitted to our hospital after 2 days of fever, cough, dyspnea, and general fatigue. A chest radiograph obtained at the time of admission revealed an infiltrate in the left lower lobe suggestive of pneumonia. A transthoracic echocardiogram demonstrated vegetation on the mitral valve and pulmonary hypertension. On the 21st hospital day she suffered hemoptysis (approximately 300 cm3); emergent plain thoracic CT study revealed left lower lobe infiltration indicative of pneumonia. The attending physician continued aggressive antibiotic therapy. However, on the 35th day, she again manifested hemoptysis (450 cm3); emergent contrast-enhanced thoracic CT clearly showed a left pulmonary pseudoaneurysm within the left lung infiltrate. After consulting with her physician and interventional radiologists, we decided to deliver endovascular treatment and she underwent selective coil embolization with microcoils. Although the vegetation on the mitral valve persisted echocardiographically and her pulmonary hypertension was not abated, her clinical symptoms resolved. There has been no sign of recurrence 1 year after embolization.