Pulmonary Artery Aneurysm Associated with a Bicuspid Pulmonary Valve: A Case Report of an Unusual Cause of Atypical Chest Pain

Abstract Background Pulmonary artery aneurysm (PAA) is a rare condition, most commonly associated with pulmonary arterial hypertension. Its association with a bicuspid pulmonary valve is exceptionally uncommon. Case summary A 62-year-old woman presented with recurrent chest pain and dyspnoea, with persistently elevated D-dimer levels leading to repeated investigations for pulmonary embolism. Serial imaging demonstrated progressive pulmonary artery dilatation. Multimodality imaging identified a bicuspid pulmonary valve and a 54 mm pulmonary artery aneurysm. Given aneurysm size and persistent symptoms, the patient underwent pulmonary arterioplasty with aneurysm resection. Intraoperative findings required patch enlargement with bovine pericardium. The postoperative course was uneventful, with complete symptom resolution and no recurrence on follow-up. Discussion This case highlights a rare association between PAA and bicuspid pulmonary valve and underscores the role of multimodality imaging in diagnosis. Surgical repair may be considered in symptomatic patients and in selected patients with large or progressively enlarging aneurysms.