Pulmonary artery obstruction caused by thoracic aortic dissection: a case with unique pathological findings.
Pulmonary artery obstruction is a rare complication of acute thoracic aortic dissection. A 74-year-old woman was admitted to hospital with respiratory distress. Computed tomography scan showed right pulmonary artery occlusion and a thoracic aortic dissection of the Stanford A type. Lung perfusion scan revealed a defect in the entire right lung field. These findings mimicked acute pulmonary thromboembolism accompanying aortic dissection. On the other hand, pulmonary angiography revealed a round smooth defect of the right pulmonary artery, indicating an extrinsic compression. The patient finally died of cardiac tamponade. Autopsy disclosed that the right pulmonary artery was compressed by a hematoma in the adventitial space around the pulmonary artery. Such a mechanism of pulmonary artery obstruction caused by acute aortic dissection is unique, and is distinct from that caused by chronic non-dissecting aortic aneurysms, which themselves compress the pulmonary arteries. This complication inevitably follows aortic rupture; therefore, emergency operation to repair the dissected aorta must be performed to avoid the following catastrophic event.
Masuo
Masatoshi
M
Department of Cardiology, Social Insurance Central General Hospital, Tokyo, Japan.
Takano
Haruhito
H
Takamoto
Satoru
S
Tanaka
Jun
J
Kitamura
Shigehiro
S
Saito
Toshikazu
T
D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000473:pathology; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000473:pathology; D001157:Arterial Occlusive Diseases / Q000209:etiology* / Q000473:pathology; D002305:Cardiac Tamponade / Q000209:etiology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006406:Hematoma / Q000209:etiology; D006801:Humans; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000473:pathology; D011655:Pulmonary Embolism / Q000175:diagnosis; D012128:Respiratory Distress Syndrome / Q000209:etiology; D014057:Tomography, X-Ray Computed