Rare Presentation of Left Lower Lobe Pulmonary Artery Dissection

Abstract

Background. Pulmonary arterial dissection with chronic pulmonary arterial hypertension as its major cause is a very rare but life-threatening condition. In most cases the main pulmonary trunk is the affected site usually without involvement of its branches. Segmental or lobar pulmonary artery dissection is extremely rare. Case Presentation. We report a unique case of left lower lobe pulmonary artery dissection in a 70-year-old male, with confirmed chronic pulmonary hypertension. To confirm dissection MDCT pulmonary angiography was used. Multiplanar reformation (MPR) images in sagittal, coronal, oblique sagittal, and curved projections were generated. This case report presents morphologic CT features of rare chronic left lobar pulmonary artery dissection associated with chronic pulmonary hypertension at a place of localised pulmonary artery calcification. CT pulmonary angiography excluded signs of thromboembolism and potential motion or flow artefacts. Conclusion. To the best of our knowledge, no case of lower lobe pulmonary artery dissection with flap calcification has been reported yet. CT imaging of the chest is a key diagnostic tool that is able to detect an intimal flap and a false lumen within the pulmonary arterial tree and is preferred in differential diagnosis of rare complications of sustained pulmonary arterial hypertension.

Disección de la arteria pulmonar en cardiopatía chagásica

“…The most frequent presentations are chest pain, dyspnea, cyanosis, hemoptysis, shock and death; dyspnea being the most common symptom in 82% of cases, while retrosternal chest pain and cyanosis have been described in 67% and 52% of cases, respectively. 11,12 Radiographic findings are nonspecific: cardiomegaly, dilatation of the trunk of the pulmonary artery and pleural effusion. 13 Computed tomographic angiography is a useful diagnostic tool in suspected pulmonary artery dissection; however, its diagnostic performance has not been established due to the minority of reported cases.…”

A rare case of right pulmonary segmental artery dissection following pacemaker insertion

“…Only two cases have been formally reported in the literature 2. Subclavian vein puncture is a relatively safe technique for placement of pacemaker leads; however, it can cause trauma if the guidewire is misplaced 3.…”