Pulmonary Artery Dissection: A Fatal Complication of Pulmonary Hypertension

Abstract

Pulmonary artery dissection is extremely rare but it is a really life-threatening condition when it happens. Most patients die suddenly from major bleeding or tamponade caused by direct rupture into mediastinum or retrograde into the pericardial sac. What we are reporting is a rare case of a 46-year-old female patient whose pulmonary artery dissection involves both the pulmonary valve and right pulmonary artery. The patient had acute chest pain and severe dyspnea, and the diagnosis of pulmonary artery dissection was confirmed by ultrasonography and CT angiography. Moreover, its etiology, clinical manifestations, and management are also discussed in this article.

Figure 1

Plain radiographic features of pulmonary artery dissection. Posteroanterior chest radiograph showing cardiac enlargement and pulmonary arterial overcirculation. Pulmonary arterial overcirculation is indicated by prominent pulmonary arterial segments and greatly dilated hilar vessels.

Figure 2

Echocardiogram. Two-dimensional transthoracic echocardiography in short-axis view of the heart base showing a greatly dilated pulmonary trunk with the dissection membrane (+). AO, aorta; LA, left atrium; T, true lumen; F, false lumen.

Figure 3

Intimal flap features determined on CT angiography. Transverse sections of CT pulmonary angiography (a, b) showing dilated central pulmonary arteries with an intimal flap (black arrow) in the main pulmonary trunk and right pulmonary artery. Pericardial effusion (white arrowheads) and bilateral pleural effusion (white arrows) are also noted. Sagittal MPR reconstruction (c) revealed the primary entry tear (arrow) in the proximal main pulmonary trunk and retrograde extension of the intimal flap to the pulmonary valve. Volume rendered images (d) vividly demonstrated the relationship between the intimal flap and pulmonary artery root.