Case report: extensive pulmonary and aortic thrombosis and ectasia.
Progressive shortness of breath developed in an elderly woman with a 25-year history of recurrent superficial phlebitis and hemoptysis. Extensive mural thrombosis and ectasia of the large and medium-sized pulmonary arteries and aorta were revealed on echocardiography and computerized tomography. The patient died 2 months later. On autopsy, the gross morphologic findings were similar with those observed by imaging. Histologically, there was mild inflammation in the intima and media of the aorta and the large pulmonary arteries, consistent with nonspecific arteritis. The extensive thrombosis and ectasia of the pulmonary arteries and aorta differ from previously published cases and cannot be assigned to a known nosologic entity. Two alternative explanations are proposed. First, an endothelial disorder was responsible for a diffuse vasculopathy that involved veins, pulmonary arteries, and aorta. Second, a vasculopathy of the Hugh-Stovin type, characterized by phlebitis and pulmonary thromboembolism, caused pulmonary hypertension and low cardiac output. The low flow state favorized aortic thrombosis and, at the site of interaction between the clot and the arterial wall, arteritis developed as an epiphenomenon, which induced arterial dilatation. Combined idiopathic pulmonary artery and aortic thrombosis and ectasia is rare and calls for corroboration of sporadic observations such as the current one.
Naschitz
J E
JE
Department of Internal Medicine A, Bnai-Zion Medical Center, Haifa, Israel.
Zuckerman
E
E
Sharif
D
D
Croitoru
S
S
Sabo
E
E
Abinader
E G
EG
D001011:Aorta / Q000473:pathology*; D001344:Autopsy; D004452:Echocardiography; D005260:Female; D006469:Hemoptysis / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D010689:Phlebitis / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D011651:Pulmonary Artery / Q000473:pathology*; D013927:Thrombosis / Q000209:etiology / Q000401:mortality*; D014057:Tomography, X-Ray Computed