Author + information
- Received July 3, 2012
- Revision received July 12, 2012
- Accepted July 17, 2012
- Published online February 12, 2013.
- Purendra K. Pati, MBBS, MD, DM(Card),
- Paul V. George, MBBS, MD, DM(Card) and
- Jacob V. Jose, MBBS, MD, DM(Card)
A 40-year-old man presented with left-sided chest pain of 1 week in duration. He had tachycardia, tachypnea, and an early diastolic murmur with Marfanoid features.
Chest x-ray showed gross cardiomegaly and a prominent main pulmonary artery (A). Echocardiography showed a grossly dilated pulmonary artery with a dissection flap (B, Online Video 1). Thoracic computed tomography complemented echocardiography and showed moderate pericardial effusion (C, D). The patient was sent for surgical repair, but he died before it could be done.
Aortic dissection is common, but the incidence of pulmonary artery aneurysm and dissection is low (1). The usual presentation is cardiogenic shock or sudden death. Diagnosis is usually made postmortem. With increased index of suspicion and improved diagnostic tools, diagnosis is now possible during life (2). The condition is usually caused by pulmonary arterial hypertension but can present without it. The outcome is fatal if secondary to pulmonary arterial hypertension (1). Management includes emergency surgery with aneurysmorrhaphy, aneurysmectomy, or lung transplantation; otherwise, the outcome is fatal, as in our case.
- Received July 3, 2012.
- Revision received July 12, 2012.
- Accepted July 17, 2012.
- American College of Cardiology Foundation