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Weekly Chest CasesArchive of Old Cases

Case No : 785 Date 2012-11-12

  • Courtesy of Su Jin Hong, Tae Jung Kim, Kyung Won Lee / Seoul National University Bundang Hospital
  • Age/Sex 44 / F
  • Chief Complaintabnormality on screening chest radiograph
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Figure 1.

Diagnosis With Brief Discussion

Diagnosis
Unilateral pulmonary artery interruption. (Pulmonary artery agenesis, unilateral absence of a pulmonary artery)
Radiologic Findings
Chest radiograph shows volume loss of left lung with mediastinal shifting to the left side. Right lung is hyperinflanted. Contrast-enhanced CT scan shows complete absence of left pulmonary artery with hypoplastic left lung and right aortic arch. Systemic collateral formation from bronchial, intercostal and inferior phrenic arteries is also noted. CT scan obtained with lung window setting shows multiple linear opacities perpendicular to the pleural surface that correspond to traspleural systemic vessels. There is no evidence of cardiomegaly, pulmonary hypertension and TOF.
Brief Review
Proximal interruption of the right or left pulmonary artery is an uncommon developmental anomaly. Blood is supplied to the lung through collateral systemic vessels, mainly bronchial arteries but also transpleural branches of the intercostal, internal mammary, subclavian, and innominate arteries. Interruption of the left pulmonary artery is usually associated with a right aortic arch and other congenital cardiovascular anomalies.
Chest radiographs typically show a volume loss in the hemithorax. In patients with enlarged intercostal and transpleural arteries, fine linear opacities are seen at the periphery of the lung. On CT scans, the mediastinal portion of the affected pulmonary artery may be completely absent or may terminate within 1 cm of its origin. Serrated thickening of the pleura and subpleural parenchymal bands also may appear on CT scans and may be attributable to direct anastomosis of transpleural collateral vessels with peripheral branches of the pulmonary artery.
In the differential diagnosis, acquired causes of pulmonary obstruction (chronic thromboembolic occlusion, Takayasu arteritis, and mediastinal fibrosis) must be ruled out.
References
Castaner E, Gallardo X, Rimola J et al. Congenital and acquired pulmonary artery anomalies in the adult: radiologic overview. Radiographics 2006; 26:349-371
Keywords
vascular, congenital,

No. of Applicants : 101

▶ Correct Answer : 66/101,  65.3%
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - SNUH , Korea (South) Euijin Hwang
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Hangang Sacred Heart Hospital , Korea (South) Younghwan Ko
  • - Scans world , India Philson Mukkada
  • - Chonnam national univ. hospital , Korea (South) Choi Seul-Gi
  • - Goa Medical College , India Paresh Desai
  • - Centre Hospitalier Lyon Sud , France matthieu ROUSSET
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - University of British Columbia , Canada Amr Ajlan
  • - UWO , Canada S Lee
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Koo Hye Soo
  • - Myongi , Korea (South) soon Moon
  • - Regional Medical Center , Kazakhstan Svetlana Kuzmenko
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Saint Malo , France jean-baptiste Noel
  • - GHICL , France manuel toledano
  • - Himeji St.Mary Hospital , Japan Yuichiro Kanie
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - HIA Legouest - METZ , France Alban Gervaise
  • - Kyung Hee University Medical center , Korea (North) Myung You
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - Cabinet de Pneumologie , Reunion Marc Di Francia
  • - KING SALMAN IBN ABDULAZIZ UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - MITOYO GENERAL HOSPITAL , Japan Mototsugu Saeki
  • - Medicheck health care , Korea (South) Chae Lim
  • - CNUH , Korea (South) Kim SooHyun
  • - , Korea (South) Kim mo
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - XiangYa hospital , China Xia Yu
  • - radiologist, aditya imaging centre , India vivek patel
  • - Pneumology GHSR , Reunion fabrice paganin
  • - GM InHospital , Korea (South) Ju Won Lee
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - fmmc , India subas kandimalla
  • - Hanyang University Hospital , Korea (South) Jina Park
  • - China Medical University , Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
  • - chp st martin , France Mariotte benoit
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - CH de la C�te Basque , France Paul ARDILOUZE
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Daejeon Eulji medical center , Korea (South) Ja Young Kim
  • - Chungbuk univertisy hospital , Korea (South) Soohyun Lee
  • - Chungbuk national university hospital , Korea (South) Jisun Lee
  • - , Korea (South) Sanghyuk Ahn
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - blue hosptial , Turkey sukru sahin
  • - IRSA , France, Metropolitan BIGOT
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - CAC Rennes , France nicolas gautier
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - All India Institute of medical sciences , India Justin Moses
  • - NASA SCANS , India RAKESH BHATIA
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
▶ Correct Answer as Differential Diagnosis : 5/101,  5.0%
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Severance hospital , Korea (South) MINA PARK
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - PUSAN NATIONAL UNIVERSITY YANGSAN HOSPITAL , Korea (South) Wonjin Choi
▶ Semi-Correct Answer : 10/101,  9.9%
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Vikram hospital , India Pravin Mahadevappa
  • - Heart Center Pontica , Bulgaria VLADISLAV RUSINOV
  • - institute of chest diseases,calicut,kerala,india. , India sabir
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Az Osp Santa Maria Terni , Italy angelo carloni
  • - Dong-A University Hospital , Korea (South) Ji-yeon Han
  • - CHRU Lille , France Paul Lebert
  • - PNUYH , Korea (South) Jieun Roh
  • - Alswaida- zaid alsherity hospital , Syria jehad alakabani
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