Mycotic aneurysm of the pulmonary artery. A report of 2 cases.

Isolated mycotic saccular aneurysm of the left pulmonary artery as a result of acute bacterial endarteritis complicating persistent ductus arteriosus is described in 2 children aged I3 years and 7 years. Successful resection of the aneurysm was accomplished in the first child. The second child had associated aortic incompetence and succumbed from cardiac failure while awaiting operation. Aneurysms of the main pulmonary artery are uncommon. Deterling and Clagett (I947) in their survey of Io9,57i necropsies from various centres recorded 8 cases only of pulmonary artery an-eurysms. They further reviewed 35 proven cases at necropsy from the published reports and one of their own. In 2I per cent of cases the pulmonary artery aneurysms were associated with persistent ductus arteriosus, and mycotic aneurysms were found in 4 cases. Kauflman, Lynfield, and Hennigar (I967), in reviewing 9 cases of multiple mycotic pulmonary artery aneurysms associated with congenital heart diseases (including one case quoted by Deterling and Clagett, and one of their own), noted 6 cases associated with persistent ductus arteriosus, 5 of which had aneurysm of the trunk of the pulmonary artery besides multiple peripheral an-eurysms. Another case associated with ventricular septal defect also had an aneurysm of the trunk of the pulmonary artery. Isolated case reports and Zuberbuhler, I970) have also drawn attention to the frequent association of pulmonary artery aneurysm with persistent ductus arteriosus. In the University Hospital, Kuala Lumpur, out of the 86 cases of persistent ductus arteriosus seen during the period I968 to I972, 2 cases of mycotic pulmonary artery aneurysm were encountered and form the basis of this report. Case reports Case I A 13-year-old asymptomatic Indian girl was admitted because of a history of io days of fever, chills, rigors with sweating, dyspnoea, and praecordial chest pain on exertion. She was previously diagnosed as having a persistent ductus arteriosus and was awaiting operation. On physical examination, no cutaneous stigmata of subacute bacterial endocarditis were noticed. Her pulse rate was iio/min regular, collapsing with a blood pressure of 130/50 mmHg. Examination of the heart revealed left ventricular hypertrophy. The typical continuous murmur of a persistent ductus arteriosus was heard maximally over the second left intercostal space. The second sound was of normal intensity. Her lungs were clear and there was no hepatosplenomegaly. Right loin tenderness was present. A provisional diagnosis of persistent ductus arteriosus with subacute bacterial endo-carditis and urinary tract infection was made. Investigations revealed a …