Korean J Radiol.  2012 Aug;13(4):496-499. 10.3348/kjr.2012.13.4.496.

Spontaneously Developed Pulmonary Arterial Intramural Hematoma That Mimicked Thromboembolism

• Kang EJ
• Lee KN
• Kim I
• Chae JM
• Kim GJ
• Yang DH
• Lee J

• KMID: 1383863
• DOI: http://doi.org/10.3348/kjr.2012.13.4.496

Abstract

A 65-year-old woman visited our hospital with a complaint of acute onset dyspnea and radiological manifestations of pulmonary thromboembolism. The patient underwent an exploratory surgery to find a whitish-blue colored mass occupying almost the whole lumen of the main pulmonary arteries. Based on the pathological and radiological findings, the patient was diagnosed to have a pulmonary arterial intramural hematoma. Intramural hematomas are usually observed in the walls of the aorta, and we believe that an isolated intramural hematoma in the pulmonary artery has not been described previously.

Keyword

Pulmonary artery; Intramural hematoma; CT; Ultrasound

MeSH Terms

Aged
Contrast Media/diagnostic use
Diagnosis, Differential
Echocardiography
Electrocardiography
Female
Hematoma/*diagnosis/*surgery
Humans
Magnetic Resonance Imaging
*Pulmonary Artery
Thromboembolism/diagnosis
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 65-year-old woman visited our hospital with acute onset dyspnea. Chest radiography (A) shows markedly decreased volume of left lung with architectural distortion and prominent bilateral pulmonary arteries. Aortic arch and descending aorta shows diffuse wall calcifications, luminal dilatation and stenosis throughout aorta. Transthoracic echocardiography (B) demonstrates significant dilatation of pulmonary trunk and huge (4.0 × 2.6 cm), solid hyperechoic mass occupying pulmonary trunk and bilateral main pulmonary arteries. Contrast-enhanced chest CT (C) documents presence of homogeneous (about 75 HU of density) mass with near total luminal obstruction of bilateral pulmonary arteries (not shown in this figure). Cardiac magnetic resonance imaging (MRI) reveals that mass is heterogeneously iso to high signal intensity on both T1- (D) and T2-weighted images (E). Also noted, capsule-like high signal intensity (arrows) at boundary with pulmonary arterial lumen. F. Surgeon's view of opened pulmonary trunk bifurcation reveals large, encapsulated, whitish-blue colored mass that occupies almost whole lumen of main pulmonary arteries. G. Histological specimen (40 × magnification) after special staining for smooth muscle antigen (smooth muscle antigen) reveals blood clots within capsule that contain smooth muscle (stained in brown color). Histological findings suggest intramural hematoma rather than chronic thrombus with pseudocapsulation or vascular tumors.

Reference

1. Sheu JJ, Fu M, Lee FY, Ng SH, Wan YL, Ko SF. Ascending aortic dissecting aneurysm with isolated right pulmonary arterial medial intramural hematoma. Ann Thorac Surg. 2008. 85:2127–2128.

2. Steurer J, Jenni R, Medici TC, Vollrath T, Hess OM, Siegenthaler W. Dissecting aneurysm of the pulmonary artery with pulmonary hypertension. Am Rev Respir Dis. 1990. 142:1219–1221.

3. Rosenson RS, Sutton MS. Dissecting aneurysm of the pulmonary trunk in mitral stenosis. Am J Cardiol. 1986. 58:1140–1141.

4. Mohammad K, Sahlol M, Egiebor O, Sadikot RT. Idiopathic pulmonary artery dissection: a case report. J Med Case Rep. 2009. 3:7426.

5. Lee JE, Kim JH, Kang MK, Park HJ, Lee JH, Kim EK, et al. A case of pulmonary arterial thrombosis in a patient with tuberculous-destroyed lung and pulmonary hypertension. Tuberc Respir Dis. 2008. 64:28–32.

6. Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum. 1990. 33:1129–1134.