(Figures 2c & 2d).
The present case demonstrates a rare combination of mycotic pulmonary artery aneurysm (MPAA) in the setting of congenital heart disease (CHD) and IE. In a congenitally malformed heart, due to turbulence and sheer force in the blood, the endocardium gets disrupted resulting in seeding of pathogenic organisms in scarred endocardium, predisposing to development of vegetations and IE. MPAA are formed in such conditions as a result of the direct extension of intraluminal septic thrombo-embolus into the vessel wall. The most common CHD associated with MPAA are PDA,VSD and corrected Tetralogy of Fallot (TOF), in addition to intravenous drug abuse and connective tissue disorders. [1,2]‘ The most important differential diagnosis for MPAA occurring in the background of CHD and IE is Rasmussen’s aneurysm. The latter is located in relation to tuberculous cavity and usually distributed beyond the branches of the main pulmonary arteries in contrary to aneurysm in CHD where it is located more proximally involving lobar branches. The management of these patients is difficult due to a lack of clear guidelines and sparse clinical experience. The prognosis for mycotic aneurysms of the pulmonary arteries without intervention is horrid with mortality rates ranging from 40–82% due to rupture. Prompt diagnosis and timely management is essential to prevent rupture and catastrophic haemorrhage in these patients. This case highlights the role of CTA in the evaluation of patients with IE and suspected MPAA as it outpaces TTE not only in terms of characterization of the aneurysm but also in demonstrating the extent of thrombo-embolic complications in distal pulmonary arteries and lung parenchyma.