[Infectious pulmonary artery pseudoaneurysms in 3 children and literatures review]

Objective: To summarize the clinical characteristics and prognosis of infectious pulmonary artery pseudoaneurysm (IPAP) in pediatric patients. Methods: This case series study summarizes the clinical data of 3 children diagnosed with IPAP at the Children's Hospital of Chongqing Medical University from January 2015 to December 2024.A comprehensive literature review was conducted by searching Chinese databases (China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, China VIP Database and Chinese Medical Journals Full Text Database) and the PubMed database through December 2024, using the keywords"infect""pseudoaneurysm""pulmonary artery". The clinical characteristics and prognosis of IPAP were synthesized by combining the reviewed literature. Results: The 3 cases included a 2-month-old male infant, a 6-year-3-month-old male child, and a 12-year-old female child, all of whom presented with fever and various respiratory symptoms. Case 1 was complicated by a retro-orbital abscess, Case 2 had a history of chronic granulomatous disease and psoriasis, and Case 3 was diagnosed with patent ductus arteriosus. Enhanced CT imaging in all 3 cases revealed multiple IPAP, with 2 cases associated with pulmonary infection foci and 1 case linked to infective endocarditis. Accompanying complications included pleural effusion in all 3 cases, necrotizing pneumonia in 2 cases, and pulmonary embolism in 1 case. Of the 3 cases, 2 cases showed improvement after anti-infective treatment, while 1 case resulted in death. A total of 9 English-language studies were identified, while no suitable Chinese-language studies were found. Including these 3 cases, a total of 12 pediatric IPAP cases were analyzed. The predominant clinical manifestations included fever in 10 cases, cough in 6 cases and hemoptysis in 5 cases. The most frequently identified pathogen was methicillin-resistant Staphylococcus aureus (MRSA) found in 3 cases. Additionally, 6 cases were complicated by extra-pulmonary infections, 4 cases had a history of congenital heart disease and surgical intervention, 1 case underwent rectovestibular fistula repair and 4 cases exhibited immune dysfunction. Imaging characteristics revealed that 9 of the 12 cases were associated with pulmonary infection foci, while 1 case was related to infective endocarditis, and 2 cases had insufficient imaging data for accurate classification. A total of 7 cases presented with a single IPAP, predominantly located in the right lower lobe in 3 cases, while the remaining 5 cases had multiple IPAP. IPAP was complicated by pleural effusion in 8 cases, by necrotizing pneumonia in 8 cases (1 of which was suspected), and by lung abscess and pulmonary embolism in 3 cases each. Among the 12 cases, 5 cases received anti-infective therapy without lobectomy or embolization, of which 3 cases improved, 1 case showed no response, and 1 case died. Additionally, 6 cases underwent endovascular embolization, with 4 cases showing improvement and 2 cases resulting in death. Only 1 case underwent lobectomy and was discharged in stable condition. Conclusions: IPAP in children manifests with a broad spectrum of clinical signs, frequently accompanied by extra-pulmonary infections and immune dysfunction. Enhanced CT plays a crucial role in the diagnosis of IPAP. The prognosis of IPAP is closely linked to the treatment approach, and timely diagnosis along with personalized treatment are essential for improving survival rates.