J Korean Med Sci.  2014 Nov;29(11):1577-1582. 10.3346/jkms.2014.29.11.1577.

Main Pulmonary Artery Dilatation in Patients with Anthracofibrosis

• Ko JM
• Park HJ

• KMID: 2069942
• DOI: http://doi.org/10.3346/jkms.2014.29.11.1577

Abstract

This study assessed main pulmonary artery diameter of patients with anthracofibrosis. Patients with anthracofibrosis and CT scans were evaluated after exclusion of patients with co-existing disease. We measured the diameter of the main pulmonary artery (PAD) and ascending aorta (AD) and calculated the pulmonary artery to aorta ratio (APR). The upper reference limit for comparison of PAD was 29 mm. Cut-off values for PAD and APR indicating pulmonary hypertension were 33 mm and 1. We correlated the CT parameters with echocardiographic results. Total 51 patients were included in the analysis. The mean PAD, AD, and APR were 33 mm, 38 mm, and 0.87 respectively. The PAD was larger than the upper reference limit, 29 mm (P<0.001). The PAD was >33 mm in 30 (65%) and the APR was >1 in 9 patients (18%). Of 21 patients with echocardiography, 11 (52%) were found to have pulmonary hypertension. There was no statistical difference in the diagnosis of pulmonary hypertension between echocardiography and CT (P=1.000). In conclusion, main pulmonary artery is dilated in patients with anthracofibrosis more than in the healthy population.

Keyword

Pulmonary Artery; Bronchostenosis; Tomography, X-Ray Computed

MeSH Terms

Aged
Aged, 80 and over
Aorta, Thoracic/*radiography
Bronchi/pathology
Bronchoscopy
Dilatation
Female
Fibrosis
Humans
Hypertension, Pulmonary/*diagnosis/ultrasonography
Male
Pulmonary Artery/*radiography
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 An 83-yr-old woman with anthracofibrosis and pneumonia. (A) An axial CT image in the lung window setting shows multifocal smooth bronchial narrowing of segmental bronchi of both upper lobes. Faint ground glass attenuation and micronodules are also seen in these lobes, which are suggestive of pneumonia with bronchiolitis. (B) An axial CT image in the mediastinal window setting at the same level of Fig. 1A shows peribronchial soft tissue cuffing around the stenotic bronchi (arrows), which is typical of anthracofibrosis. (C) An axial CT image at the level of bifurcation of the pulmonary artery. Pulmonary artery diameter, aorta diameter and aorta-pulmonary artery ratio are 40 mm, 39 mm, and 1.02, respectively. Pneumonic consolidation is seen in the right upper lobe. Bronchostenosis with peribronchial soft tissue cuffing is also visible in the lingular divisional bronchus and superior segmental bronchus of the left lower lobe (arrow). (D) On bronchoscopy, black pigmentation overlying the stenotic bronchi is present in both lungs, which is diagnostic of anthracofibrosis. Echocardiography revealed pulmonary hypertension with pulmonary regurgitation. At that time, the patient was diagnosed with essential pulmonary hypertension since no other causes had been identified.

• 

  Fig. 2 An 82-yr-old male with anthracofibrosis. (A) An axial CT image shows bronchostenosis with peribronchial soft tissue cuffing in the right middle lobe (arrow). Peribronchovascular fibrotic cuffing is also seen around the left interlobar artery, resulting in vascular narrowing (double arrows). The right main pulmonary artery is markedly dilated, and bilateral pleural effusions are present. (B) An axial CT image shows increased pulmonary artery diameter (39 mm) and aorta-pulmonary artery ratio (1.11). (C) Bronchoscopy revealed typical anthracofibrosis with multifocal bronchostenosis and overlying black pigmentation. Echocardiography showed pulmonary hypertension. The patient was diagnosed with essential pulmonary hypertension and cor pulmonale at that time since no other causes had been identified.

• 

  Fig. 3 A 76-yr-old female with anthracofibrosis. (A) An axial CT image in the lung window setting shows mild bronchostenosis of the anterior segmental bronchus of the right upper lobe (arrow). (B) An axial CT image in the mediastinal window setting shows soft tissue cuffing around the bronchovascular bundles (white arrows) and associated bronchostenosis. The left interlobar artery is stenotic and the right middle lobar artery is not visible. (C) Axial CT scan shows increased pulmonary artery diameter (37 mm) and aorta diameter (40 mm), and normal aorta-pulmonary artery ratio (0.93). (D) Bronchoscopy revealed bronchostenosis with anthracotic pigmentation. Echocardiography revealed pulmonary hypertension.

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