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Pulmonary artery dissection: MR findings
1Department of Radiology, University of California, San Francisco 94143-0628.
Abstract:
We report a case of pulmonary artery dissection imaged by MR. Dissection of a markedly dilated pulmonary artery is a rare and usually fatal complication of chronic pulmonary arterial hypertension. The diagnosis is made at autopsy, with only two cases having previously been documented (by Doppler echocardiography) during life. The hallmark of an arterial dissection is the finding of an intimal flap and a false lumen. In our case, spin echo MR imaging failed to show either the intimal flap or any intraluminal signal defects. The dissection was presumably obscured by nonhomogeneous intraluminal signal caused by the slow blood flow associated with severe pulmonary arterial hypertension. Cine MR imaging, however, demonstrated different signal intensity within the true and false lumens of the dissection, thereby outlining the intimal flap between the two channels.
Insights
Pulmonary artery dissection, a rare complication of pulmonary arterial hypertension, was diagnosed using cine Magnetic Resonance (MR) imaging. This technique effectively visualized the intimal flap, overcoming limitations of standard spin echo MR in this specific case.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Pulmonary Hypertension
Background:
- Pulmonary artery dissection is a rare, often fatal complication of chronic pulmonary arterial hypertension.
- Diagnosis is typically made post-mortem, with few ante-mortem cases documented via Doppler echocardiography.
Observation:
- A case of pulmonary artery dissection in a patient with severe pulmonary arterial hypertension was evaluated using Magnetic Resonance (MR) imaging.
- Standard spin echo MR imaging failed to clearly delineate the dissection due to signal heterogeneity from slow blood flow.
Findings:
- Cine MR imaging successfully identified the intimal flap and false lumen characteristic of dissection.
- Differential signal intensity within the true and false lumens on cine MR provided clear visualization of the dissection anatomy.
Implications:
- Cine MR imaging offers a valuable diagnostic tool for pulmonary artery dissection, especially when conventional MR sequences are limited.
- Improved ante-mortem diagnosis of pulmonary artery dissection can potentially alter patient management and outcomes.