PMC4840406_01
Chest radiography exhibited cardiomegaly and hyper-expanded lungs with enlarged right-sided pulmonary artery (white arrow) suggestive of severe cor-pulmonale secondary to COPD.
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Chest radiography revealed a large right-sided pulmonary artery with an enlarged pulmonary outflow tract and moderate cardiomegaly suggestive of cor-pulmonale (Fig. 1). This CT-DSA did not reveal any intimal flap or contrast extension to the media of pulmonary arterial wall, thus helped ruling out a pulmonary artery dissection (Fig. 4, Video 1 and 2).
Coronal reformat from contrast enhanced CT Pulmonary angiogram showed extensive confluent non-occlusive filling defect (white arrow) in a grossly dilated right pulmonary artery that extended to the 2nd, 3rd and 4th order pulmonary arterial branches. No filling defect was seen in the left pulmonary artery and its branches.
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Contrast enhanced CT Pulmonary Angiogram (CTPA) with a standard 64-slice CT revealed extensive confluent non-occlusive filling defect in a grossly dilated right pulmonary artery that measured 6cm in calibre (Fig. 2). This CT-DSA did not reveal any intimal flap or contrast extension to the media of pulmonary arterial wall, thus helped ruling out a pulmonary artery dissection (Fig. 4, Video 1 and 2).
Transverse image from the same CT Pulmonary Angiogram at a lower level demonstrated a circumferential smooth cuff of soft tissue density (white arrow) up until the 4th order pulmonary artery branches which required the exclusion of a pulmonary artery dissection.
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The presence of circumferential cuff of soft tissue more distally within a sub-segmental pulmonary artery branch made the differentiation between thrombosis and pulmonary artery dissection very difficult (Fig. 3).
Representative images from CT-DSA of pulmonary arteries in coronal plane showed calcification (long white arrow) in the deep layer of filling defect suggestive of chronic thrombus on the pre-contrast phase (a), thrombus in the dilated pulmonary arteries (star) and contrast flow turbulence (short arrow) on the very early (b), early (c) and full (d) arterial contrast enhanced phases. There was no evidence of any intimal flap or contrast extension into the media of the vessel wall to suggest any presence of dissection.
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This CT-DSA did not reveal any intimal flap or contrast extension to the media of pulmonary arterial wall, thus helped ruling out a pulmonary artery dissection (Fig. 4, Video 1 and 2).