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Case 28: Proximal Interruption of the Right Pulmonary Artery¹

¹ From the Department of Radiology, New York Presbyterian Hospital, 525 E 68th St, New York, NY 10021. Received February 22, 1999; revision requested April 8; revision received July 7; accepted July 26. Address correspondence to the author. (e-mail: sdd2001@mail.med.cornell.edu).

View larger version (128K): [in a new window]   Figure 1a. (a) Posteroanterior chest radiograph. Volume loss within the right hemithorax is indicated by elevation of the hemidiaphragm and shift of the heart, mediastinum, and tracheal air column to the right. A vertically oriented curvilinear shadow (black arrows) represents the anterior junction line that is displaced into the right hemithorax. Within the small right lung, there is a fine reticular pattern peripherally. There also appears to be pleural thickening (arrowheads) superolaterally. Rib notching (white arrows) is suggested within at least the fifth and sixth ribs. The right hilum is not well seen, but the left pulmonary artery (open arrow) appears enlarged. (b) Lateral chest radiograph. An enlarged left pulmonary artery (arrow) is visible. The retrosternal region is also more radiolucent because of hyperinflation of the left lung. (c) Close-up collimated view of the right lung from a. Reticulation within the peripheral aspect of the right lung is seen more clearly. The black arrows point to the anterior junction line, the arrowheads point to apparent pleural thickening, and the white arrows point to rib notching.

View larger version (135K): [in a new window]   Figure 1b. (a) Posteroanterior chest radiograph. Volume loss within the right hemithorax is indicated by elevation of the hemidiaphragm and shift of the heart, mediastinum, and tracheal air column to the right. A vertically oriented curvilinear shadow (black arrows) represents the anterior junction line that is displaced into the right hemithorax. Within the small right lung, there is a fine reticular pattern peripherally. There also appears to be pleural thickening (arrowheads) superolaterally. Rib notching (white arrows) is suggested within at least the fifth and sixth ribs. The right hilum is not well seen, but the left pulmonary artery (open arrow) appears enlarged. (b) Lateral chest radiograph. An enlarged left pulmonary artery (arrow) is visible. The retrosternal region is also more radiolucent because of hyperinflation of the left lung. (c) Close-up collimated view of the right lung from a. Reticulation within the peripheral aspect of the right lung is seen more clearly. The black arrows point to the anterior junction line, the arrowheads point to apparent pleural thickening, and the white arrows point to rib notching.

View larger version (116K): [in a new window]   Figure 1c. (a) Posteroanterior chest radiograph. Volume loss within the right hemithorax is indicated by elevation of the hemidiaphragm and shift of the heart, mediastinum, and tracheal air column to the right. A vertically oriented curvilinear shadow (black arrows) represents the anterior junction line that is displaced into the right hemithorax. Within the small right lung, there is a fine reticular pattern peripherally. There also appears to be pleural thickening (arrowheads) superolaterally. Rib notching (white arrows) is suggested within at least the fifth and sixth ribs. The right hilum is not well seen, but the left pulmonary artery (open arrow) appears enlarged. (b) Lateral chest radiograph. An enlarged left pulmonary artery (arrow) is visible. The retrosternal region is also more radiolucent because of hyperinflation of the left lung. (c) Close-up collimated view of the right lung from a. Reticulation within the peripheral aspect of the right lung is seen more clearly. The black arrows point to the anterior junction line, the arrowheads point to apparent pleural thickening, and the white arrows point to rib notching.

View larger version (105K): [in a new window]   Figure 2a. (a-d) Transverse contrast-enhanced cephalocaudal contiguous CT scans obtained at mediastinal window settings (width, 400 HU; level, 26 HU; 10-mm collimation) reveal an enlarged left main pulmonary artery (small arrow in b and c), but the mediastinal portion of the right pulmonary artery is completely absent. The interlobar portions (large arrow in c and d) of the right and left pulmonary arteries are depicted, but the right is diminutive compared with the left. Prominent regions of extrapleural fat (white arrowheads in a and b) contain enlarged, contrast-enhanced intercostal collateral vessels (black arrowheads in a and b); this finding of extrapleural fat accounts for the appearance of pleural thickening on the chest radiograph.

View larger version (106K): [in a new window]   Figure 2b. (a-d) Transverse contrast-enhanced cephalocaudal contiguous CT scans obtained at mediastinal window settings (width, 400 HU; level, 26 HU; 10-mm collimation) reveal an enlarged left main pulmonary artery (small arrow in b and c), but the mediastinal portion of the right pulmonary artery is completely absent. The interlobar portions (large arrow in c and d) of the right and left pulmonary arteries are depicted, but the right is diminutive compared with the left. Prominent regions of extrapleural fat (white arrowheads in a and b) contain enlarged, contrast-enhanced intercostal collateral vessels (black arrowheads in a and b); this finding of extrapleural fat accounts for the appearance of pleural thickening on the chest radiograph.

View larger version (109K): [in a new window]   Figure 2c. (a-d) Transverse contrast-enhanced cephalocaudal contiguous CT scans obtained at mediastinal window settings (width, 400 HU; level, 26 HU; 10-mm collimation) reveal an enlarged left main pulmonary artery (small arrow in b and c), but the mediastinal portion of the right pulmonary artery is completely absent. The interlobar portions (large arrow in c and d) of the right and left pulmonary arteries are depicted, but the right is diminutive compared with the left. Prominent regions of extrapleural fat (white arrowheads in a and b) contain enlarged, contrast-enhanced intercostal collateral vessels (black arrowheads in a and b); this finding of extrapleural fat accounts for the appearance of pleural thickening on the chest radiograph.

View larger version (109K): [in a new window]   Figure 2d. (a-d) Transverse contrast-enhanced cephalocaudal contiguous CT scans obtained at mediastinal window settings (width, 400 HU; level, 26 HU; 10-mm collimation) reveal an enlarged left main pulmonary artery (small arrow in b and c), but the mediastinal portion of the right pulmonary artery is completely absent. The interlobar portions (large arrow in c and d) of the right and left pulmonary arteries are depicted, but the right is diminutive compared with the left. Prominent regions of extrapleural fat (white arrowheads in a and b) contain enlarged, contrast-enhanced intercostal collateral vessels (black arrowheads in a and b); this finding of extrapleural fat accounts for the appearance of pleural thickening on the chest radiograph.

View larger version (98K): [in a new window]   Figure 3. Transverse CT scan obtained at lung window settings (width, 2,000 HU; level, -700 HU; 3-mm collimation). Fine reticular increased attenuation (arrowheads) within the small right lung represents transpleural collateral vessels. Herniation of the hyperinflated left lung into the right hemithorax, associated with displacement of the anterior junction line (arrow), is visible.