Massive bilateral pulmonary artery aneurysms: A multimodal imaging case report

Pulmonary artery aneurysms (PAAs) are rare vascular anomalies, with bilateral involvement being exceedingly uncommon and potentially life-threatening. We describe a 35-year-old multiparous woman who presented with progressive dyspnea, hemoptysis, and chest pain over five months. On admission, she was hypoxic and coagulopathic, with laboratory findings showing anemia, leukocytosis, and markedly elevated C-reactive protein. Chest radiography demonstrated bilateral hilar enlargement, while transthoracic echocardiography revealed a massively dilated pulmonary trunk and right atrial enlargement with spontaneous echocontrast. CT pulmonary angiography confirmed the presence of massive bilateral fusiform aneurysms involving the main pulmonary artery and proximal branches, complicated by right pulmonary artery embolism but without evidence of rupture. The patient was urgently referred for surgical evaluation. This case illustrates the diagnostic challenges of bilateral PAAs in the absence of typical risk factors such as congenital heart disease, pulmonary hypertension, or connective tissue disorders. It highlights the critical role of multimodal imaging in achieving timely diagnosis, anatomical characterization, and surgical planning. Early recognition and prompt referral are essential to avert catastrophic complications in such rare presentations.