PMC10285476_01
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).
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F1
Despite the apparent complete obstruction of the right pulmonary artery, perfused blood volume (PBV) mapping of the dual energy CT study revealed areas of the right lung that were still minimally perfused (Figure 1 A,B). Pulmonary angiography clearly demonstrated complete obstruction of the right pulmonary artery (Figure 1C). Coronary angiography revealed the presence of coronary to pulmonary collaterals traveling to the pulmonary circulation from the left circumflex artery (Figure 1D).
Surgical specimen. Entire clot removed en-bloc via thromboendarterectomy.
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F2
The right pulmonary artery was opened, and the entire clot was removed en bloc from all 10 segments of the right pulmonary artery under hypothermic circulatory arrest (Figure 2).
Dual-Energy computed tomography (DECT). (A) Repeat DECT demonstrates patent pulmonary artery post-thromboendarterectomy; (B) Perfusion mapping reveals significantly improved perfusion of right lung.
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F3
Post-surgery DECT confirmed patency of the right pulmonary artery and restoration of segmental and subsegmental pulmonary arterial circulation (Figure 3A,B).