Giant Idiopathic Pulmonary Artery Aneurysm: An Interesting Incidental Finding

Idiopathic pulmonary artery aneurysm is a rare condition. This type of aneurysm can be presented with noncardiac symptoms or even asymptomatic. We report a 73-year-old man with a gigantic idiopathic pulmonary artery aneurysm which was referred to our unit for his kidney problems. During his workup we incidentally found the aneurysm by an abnormal chest-X ray and auscultation. Our further evaluations revealed a 9.8？cm aneurysm in transthoracic echocardiography. 1. Introduction Pulmonary artery aneurism (PAA) is a rare condition, mostly arising from main pulmonary artery [1]. The specific prevalence of PAA is unknown, but it was reported in 1 out of every 14000 autopsies [2, 3]. PAA is described as a dilatation of pulmonary artery (PA) [1]. Although there is no accurate definition for PAA, some studies have mentioned 4？cm of diameter as a cut-off point [1]. Subsequent studies reported the upper normal limit of main pulmonary artery (PA) diameter is 29？mm on computed tomography (CT) [4]. PAA usually presents with unspecific symptoms such as dyspnea, hemoptysis, chest pain, and cough [2]. Many medical conditions including congenital heart defects, connective tissue disorders, and pulmonary hypertension can cause PAA [1, 5]. However, idiopathic PAA is an infrequent and rarely reported lesion [3]. Noninvasive imaging techniques including magnetic resonance imaging (MRI) and CT can help clinician in diagnosis, but the gold standard diagnostic tool for PAA is pulmonary angiography [2, 4]. In this case report, we describe a case of huge main PAA with pulmonary valve atresia and right ventricular outlet tract aneurysm (RVOTA). 2. Case Presentation On May 2013, a 73-year-old man referred to emergency care unit with shortness of breath, nausea, fever, and chills. His symptoms began from a week ago. In his past medical history he only mentioned a controlled hypertension. His physical examination was normal and only a IV/VI systolic murmur and III/VI diastolic murmur were heard at the left sternal border. His Primary laboratory investigations which was taken by emergency care unit revealed potassium level of 4.7？mEq/dL (normal range between 3.5 and 5.3？mEq/dL), urea level of 66？mg/dL (normal range between 25 and 50？mg/dL), creatinine level of 2 (normal range: up to 1.5？mg/dL), and normal sodium level. His other laboratory tests were all within normal limit. Also, blood and urine cultures were taken in order to exclude infection; a chest X-ray (CXR) and an electrocardiogram (ECG) were also ordered because of his abnormal cardiac auscultation. Because of the high