PMC6803736_01
(a) Noncontrast chest CT showing main pulmonary artery aneurysm measuring 70 mm with blue arrow pointing the possible intimal flap. Rapid tapering of pulmonary vessels can be appreciated on the right lung zones. (b) Transthoracic echocardiogram apical four-chamber view showing severely dilated right ventricle and septal flattening (white arrow). (c) Transthoracic echocardiogram parasternal short axis view at the level of aortic valve showing severe dilation of pulmonary artery.
CRIC2019-1924014.001.jpg
PMC6803736_01_CRIC2019-1924014.001.jpg
fig1
Computerized tomography (CT) scan of the chest showed an aneurysm of the main pulmonary artery (PA) measuring 85 mm in diameter with an intimal flap concerning for pulmonary artery dissection (Figure 1(a)). Transthoracic echocardiogram (TTE) revealed a hypertrophied, moderately dilated, and dysfunctional right ventricle (RV) with an estimated right ventricular systolic pressure (RVSP) of 78 mmHg and severe dilation of main PA compatible with severe PH (Figures 1(b) and 1(c)).
PMC6803736_02
(a) Transthoracic echocardiogram parasternal short axis color Doppler showing severe pulmonic regurgitation (white arrow) and dilated pulmonary artery. (b) Cardiac MRI showing marked aneurysmal enlargement of the main PA.
CRIC2019-1924014.002.jpg
PMC6803736_02_CRIC2019-1924014.002.jpg
fig2
TTE revealed severe dilation with dysfunction of the RV and severe pulmonary valvular regurgitation (PVR) (Figure 2(a)). PAA and severe pulmonic regurgitation (Figure 2(b)).
PMC6803736_03
(a) CTA chest showing right pulmonary artery aneurysm measuring 80 mm in the greatest dimension with laminated thrombus in the aneurysmal sac (red arrow). (b) Transthoracic echocardiogram apical four-chamber view showing dilated RV, severe TR (white arrow), and systolic septal flattening consistent with RV pressure overload. (c) Extremely elevated estimated PA systolic pressure measurements to 134 mmHg indicating severe PH.
CRIC2019-1924014.003.jpg
PMC6803736_03_CRIC2019-1924014.003.jpg
fig3
Computerized tomography angiography (CTA) of the chest revealed a right PAA measuring 80 mm in diameter with laminated clot burden and compression of the right bronchus (Figure 3(a)). RVSP of 134 mmHg and severe tricuspid regurgitation (TR) (Figures 3(b) and 3(c)). RHC was deferred due to the presence of the aneurysm.