A huge idiopathic pulmonary aneurysm: a stable follow up

A 60 years old woman, presented 5 years ago to the cardiology department addressed by her physician for atypical chest pain. She reported no history of palpitation or dyspnea. The cardiac auscultation revealed a 3/6 systolic murmur at the left lower sternal border. The Chest radiography showed cardiomegaly with homogenous bilateral hilar opacities (A). The chest computed tomography (CT) angiography revealed a huge aneurysm of the main pulmonary artery sized 105 mm in transverse diameter (B,C,D) extending up to both left and right pulmonary arteries. It was diagnosed as idiopathic because the patient had no comorbidities that can cause a pulmonary artery (PA) aneurysm. We recommended surgery for the PA aneurysm, but the patient refused surgery, she was discharged with medication and regular follow-up; her clinical condition stayed stable and the CT scan annually controls didn´t show any increase in the PA diameter.