PMC7773639_01
Magnetic resonance transverse T2-weighted images (T2Wi) (A,B), dorsal T2Wi (C) and dorsal T1W with gadolinium (D) of the brain obtained for the initial diagnosis for MUO. (A-C) Multifocal to coalescing regions of hyperintensity on T2W are present in the left cerebral hemisphere and involve the left ventral frontal lobe, the left pyriform lobe, the left temporal lobe, and the left hippocampus. (D) The central region of the hippocampus enhances strongly with gadolinium while the remainder of the lesions do not enhance.
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F1
The following imaging sequences were obtained: sagittal T2-weighted (T2W); transverse T2W, T2*-gradient echo, T2W fluid attenuated inversion recovery, T1-weighted (T1W), T1W following IV gadolinium administration, diffusion-weighted, and apparent diffusion coefficient map; and dorsal T1W and T1W with contrast (Figure 1).
Right lateral thoracic radiographs (A) prior to treatment and (B) after 4 years of treatment for MUO. (B) Mineralization in the right and left pulmonary arteries (arrow) is seen as an elongated heterogeneous mineral opacity overlying and extending slightly dorsal and ventral to the carina. This finding is not evident in (A).
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F2
Chest radiographs revealed a large mineral opaque tubular structure in the region of the pulmonary artery (Figure 2).
Reconstructed (A) dorsal and (B) three-dimensional (3D) computed tomographic images obtained post-mortem show amorphous mineral attenuation within the right and left pulmonary arteries (arrows).
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F3
The CT confirmed that there was a mineralized thrombus occupying the entire lumen of both the right and left pulmonary arteries, causing near complete blockage (Figure 3).
PMC7773639_02
(A) Ventrodorsal and (B) left lateral thoracic radiographs taken after 5 years of treatment for MUO. (A) A tubular mineral opacity is seen in the region of the right main and right caudal lobar pulmonary artery (black arrow). Mineral opacity and loss of volume is present in the right middle and caudal segment of the left cranial lung lobes (*) with an associated rightward mediastinal shift (long horizontal line). There are also air bronchograms visible within the right middle lobe. (B) The mineral opacity in the artery is seen ventral to the carina (black arrow); it may not seem to be extending caudally and dorsally (as expected for the right caudal lobar pulmonary artery) due to significant patient rotation and altered heart position from the mediastinal shift. The mineralized alveolar pattern with loss of volume in the right middle lung lobe is evident over the middle of the cardiac silhouette (*).
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F4
Chest radiographs revealed mineralization in at least one pulmonary blood vessel, likely the right caudal lobar vessel, as well as calcification of the airways and lung parenchyma (Figure 4).