Stage IV squamous lung cancer: partial response complicated by pulmonary artery pseudoaneurysm

What happened, in summary

A 65-year-old man with a 20-year history of chronic obstructive pulmonary disease was admitted after suddenly coughing up a large amount of blood. Two months earlier, enhanced CT had shown a tumor in the right upper lung, and biopsy confirmed squamous cell carcinoma. The cancer was staged as T2bNXM1c1, consistent with Stage IV disease. He received 2 cycles of albumin-bound paclitaxel, nedaplatin, and tislelizumab. Follow-up CT showed partial remission of the tumor with cavitation, meaning the tumor had shrunk and developed a hollowed area. He then arrived at the hospital with massive hemoptysis. He was hemodynamically stable but had coughed up about 200 mL of blood and had oxygen saturation of 93%. Lab tests showed anemia, high white blood cell count, elevated neutrophils, and high C-reactive protein. Emergency CT angiography identified the cause of bleeding: a pseudoaneurysm in the right upper pulmonary artery located along the wall of the squamous-cell carcinoma cavity, with intraluminal hematoma. The bronchial and non-bronchial systemic arteries were not significantly enlarged. Interventional radiology performed emergency endovascular treatment through the right femoral vein. A catheter was advanced into the right upper pulmonary artery, and microcoils were deployed to occlude the pseudoaneurysm and its proximal artery. Post-procedure angiography confirmed disappearance of the pseudoaneurysm. He had no active bleeding after the procedure, and 6 months of follow-up showed no recurrence of hemoptysis. A CT scan 3 months after embolization showed absorption of the tumor cavity and significant tumor reduction. Follow-up focused on recovery from bleeding and continued monitoring of the reduced tumor.