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Weekly Chest CasesArchive of Old Cases

Case No : 547 Date 2008-04-21

  • Courtesy of Yoon Kyung Kim, MD, Hwan-Seok Yong, MD, Eun-Young Kang, MD. / Korea University Guro Hospital, Korea.
  • Age/Sex 27 / F
  • Chief ComplaintChest discomfort (1 month)
  • Figure 1
  • Figure 2
  • Figure 3

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 right lung with mediastinal shifting to the right side. Fine linear opacities are seen in right lung field. Right pulmonary artery shadow is not definitely noted. Contrast-enhanced CT scan shows complete absence of right pulmonary artery. Enhancing nodular lesions in right pleura suggest enlarged intercostal collateral vessels. Bronchial artery hypertrophy is also noted. CT scan obtained with lung window setting shows multiple linear opacities perpendicular to the pleural surface that correspond to transpleural systemic vessels.
Brief Review
Proximal interruption of the right or left pulmonary artery is an uncommon developmental anomaly. The term interruption is used in preference to absence of a pulmonary artery, since the portion of the vessel that is in the lung is usually intact and patent. 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. Right pulmonary artery interruption is more common than left, and it is an isolated finding in most instances.

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.

Recurrent pulmonary infection, hemorrhage, and mild dyspnea on exertion are the most common symptoms of this abnormality. Pulmonary hypertension affects 19%?5% of patients with pulmonary artery interruption and is the most important determinant of the prognosis. 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, Lung, Vascular, Congenital,

No. of Applicants : 82

▶ Correct Answer : 14/82,  17.1%
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - , Korea (South) kim hyoung
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Osaka University , Japan Osamu Honda
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - Az Osp Santa Maria , Italy angelo carloni
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - Jackson Memorial Hospital , United States Naganathan Mani
  • - The Armed Forces HamPyeong Hospital , Korea (South) Oh Geun
  • - Instituto Radiologico de Brasilia , Brazil Arismar Leon
  • - CH de la Ce Basque , France Paul ARDILOUZE
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
▶ Correct Answer as Differential Diagnosis : 6/82,  7.3%
  • - Alnoor Specialist Hospital , Saudi Arabia Ahmed Mohamed
  • - IRSA La Rochelle France , France Denis Chabassie
  • - EKH-Berlin , Germany Michael Weber
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - CMC , Korea (South) An yeong yi
  • - Asan medical center , Korea (South) Dae Yoon Kim
▶ Semi-Correct Answer : 17/82,  20.7%
  • - Asan Medical Center , Korea (South) Eun Jin Chae
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - Cheongshim international medical center , Korea (South) yang Hae Jum
  • - Hopital universitaire Lausanne , Switzerland abed kourhani
  • - Auckland City Hospital , New Zealand (Aotearoa) Remy Lim
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - Trakya University School of Medicine , Turkey Derya Demir
  • - Saga University , Japan Ryoko Egashira
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - ULTRA CARE , India Debabrata Das
  • - Soonchunhyang University Cheonan Hospital , Korea (South) Park Sang Hyun
  • - Depatment of Radiology, Yongsan Hospital, College of Medicine, Chung-Ang University , Korea (South) Jae Seung Seo
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