Incidental Discovery of an 8.2-cm Pulmonary Artery Aneurysm During Routine Ablation Evaluation.

BACKGROUND

Pulmonary artery aneurysms (PAAs) are most commonly identified in the setting of pulmonary hypertension or congenital heart disease. Large aneurysms with normal pulmonary pressures are less frequently encountered and create uncertainty regarding natural history and management.

CASE SUMMARY: We report a 73-year-old woman with prior mitral valve repair and atrial septal defect closure who underwent elective atrial tachycardia ablation, during which intraprocedural transesophageal echocardiography incidentally revealed an 8.2-cm main PAA. She was asymptomatic, and right- and left-heart catheterization demonstrated normal pulmonary pressures, so multidisciplinary evaluation favored surveillance rather than surgery.

DISCUSSION: This case highlights that very large PAAs may be incidentally identified in asymptomatic patients and require individualized risk stratification to guide management.

TAKE-HOME MESSAGES: A large PAA alone is not an automatic indication for surgical repair. Management decisions should be guided by clinical status and hemodynamic findings.