Pulmonary artery pseudoaneurysm as a neglected manifestation of pulmonary mucormycosis: a retrospective observational study

INTRODUCTION: Pulmonary artery pseudoaneurysm (PAP) is a rare but potentially fatal vascular abnormality, while its occurrence secondary to pulmonary mucormycosis (PM) is uncommon. The coexistence of PAP and PM represents an exceedingly uncommon and life-threatening condition, with only a limited number of cases reported in the literature. METHOD: We retrospectively analyzed medical records of 69 patients diagnosed with PM at the Center of Rare Lung Diseases and Respiratory Infections, National Lung Hospital, Hanoi, Vietnam, between January 2020 and April 2025. Among them, nine patients with concomitant PAP were identified, and detailed data on clinical characteristics, diagnostic evaluations, management, and outcomes were extracted from electronic medical records. RESULTS: The nine patients had a median age of 61 years (range 51-88), with males predominating and diabetes mellitus documented in eight cases, most of which were poorly controlled. Hemoptysis was mild in the majority, with only one patient developing massive bleeding. Chest CT revealed 16 PAPs (10 round type, 5-40 mm in diameter), with bilateral involvement in over half of the patients. Surrounding abnormalities of PAPs included pulmonary consolidation in all nine cases and necrosis in eight. Management included surgical resection in five patients, and antifungal therapy with amphotericin B followed by triazoles, but three patients died, two from fatal hemoptysis. CONCLUSION: Systematic screening for PAP in PM, especially in patients with poorly controlled diabetes and pulmonary consolidation or necrosis, along with early antifungal therapy and timely surgical intervention, may improve survival in this rare but life-threatening condition.