Pulmonary artery dissection: an emerging cardiovascular complication in surviving patients with chronic pulmonary hypertension

Abstract

Pulmonary arterial dissection is an extremely rare and usually lethal complication of chronic pulmonary hypertension. The condition usually manifests as cardiogenic shock or sudden death and is therefore typically diagnosed at postmortem examination rather than during life. However, recent isolated reports have described pulmonary artery dissection in surviving patients. The first case of pulmonary artery dissection in a surviving patient with cor pulmonale caused by chronic obstructive pulmonary disease is presented. The aetiology, pathophysiology, and clinical presentation of pulmonary artery dissection are reviewed and factors that may aid diagnosis during life are discussed.

Figure 3

Transverse section of a computed tomographic pulmonary angiogram showing a linear dissection (arrow) of the main pulmonary trunk.

Figure 1

Two dimensional transthoracic echocardiogram in a modified short axis view showing a greatly dilated pulmonary trunk (PT) with an intimal flap in transverse section.

Figure 2

Transthoracic echocardiogram showing longitudinal distribution of the intimal flap (arrow) originating from just above the pulmonary valve and extending to the origin of the left pulmonary artery (LPA). The presence of bidirectional flow on colour flow imaging confirms the presence of dissection with a true and false lumen. PA, pulmonary artery; RPA, right pulmonary artery.