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Case Reports
. 2023 Jun 8:10:1204736.
doi: 10.3389/fcvm.2023.1204736. eCollection 2023.

Case report: Multimodality imaging of unusual coronary to pulmonary collaterals in chronic thromboembolic pulmonary hypertension

Ansh Goyal  1 , Ryan Avery  2 , Michael J Cuttica  3 , James D Flaherty  4 , S Chris Malaisrie  1 , Ruben Mylvaganam  3
Affiliations
Case Reports

Case report: Multimodality imaging of unusual coronary to pulmonary collaterals in chronic thromboembolic pulmonary hypertension

Ansh Goyal et al. Front Cardiovasc Med. .

Abstract

We present unusual coronary-pulmonary collaterals in a 65-year-old CTEPH patient. Perfusion mapping of a dual-energy computed tomography (DECT) study revealed areas of right lung that were minimally perfused despite unilateral occlusion of the right pulmonary artery, leading to the discovery of coronary-pulmonary collaterals via invasive coronary angiography. Pulmonary thromboendarterectomy removed the clot en-bloc. Post-surgery DECT and catheterization confirmed restoration of pulmonary arterial circulation and excellent hemodynamic response. Here, suggestion of perfusion to a proximally obstructed lung with DECT helped to document the presence of rarely documented coronary-pulmonary artery collaterals.

Keywords: CTEPH; DECT; chronic thromboembolic pulmonary hypertension; collaterals; coronary angiogram; pulmonary angiography; pulmonary endarterectomy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Dual-Energy computed tomography (DECT), pulmonary and coronary angiography. (A) Coronal DECT image demonstrating obstruction of right pulmonary artery (arrowhead); (B) Perfusion mapping demonstrates limited perfusion of right lung from unknown systemic supply at time of imaging. (C) Pulmonary angiography confirmed complete obstruction of right pulmonary circulation (arrowhead); (D) Coronary angiography revealed multiple systemic coronary-pulmonary collaterals from the left circumflex artery (asterisks).
Figure 2
Figure 2
Surgical specimen. Entire clot removed en-bloc via thromboendarterectomy.
Figure 3
Figure 3
Dual-Energy computed tomography (DECT). (A) Repeat DECT demonstrates patent pulmonary artery post-thromboendarterectomy; (B) Perfusion mapping reveals significantly improved perfusion of right lung.
Figure 4
Figure 4
Timeline of events associated with the care episode.
See this image and copyright information in PMC

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