Misdiagnosis of pulmonary artery aneurysm with eroding thrombus into the airways. A fatal case of suffocation

Abstract We present a fatal case of hemoptysis following a thrombus-eroding pulmonary artery aneurysm into the left upper bronchus of a 79-year-old male with a history of multiple hospital contacts and examinations due to cough, hemoptysis, and reflux symptoms. A postmortem computed tomography (CT) scan revealed a hyperdense, condensed area in the left lung in relation to the lung hilus. At autopsy, the forensic specialist discovered a large, organized thrombus in a pulmonary artery aneurysm. The thrombus was adherent to the pulmonary artery aneurysm wall with an underlying defect directly communicating to the left upper bronchus. The cause of death was asphyxia due to blood in the airways (i.e., suffocation). The combination of pulmonary artery hypertension, previous pulmonary embolism, and hemoptysis should lead to a particularly thorough inspection of the lungs with a focus on the pulmonary circulation. This case report emphasizes the importance of early detection of patients at risk of pulmonary artery rupture and attentiveness when performing biopsies during bronchoscopy to prevent communication between the artery and the airway. The risk of rupturing an aneurysm should be taken into account when performing biopsies on excrescence intruding into the bronchus in patients with medical histories of pulmonary hypertension, cough, and sporadic hemoptysis.