Clinical and imaging characteristics of pulmonary artery dissection

To evaluate the clinical manifestations, image characteristics and prognosis of pulmonary artery dissection (PAD) compared with pulmonary hypertension (PH).

Patients diagnosed with PAD and PH were retrospectively enrolled. The clinical presentation, image characteristics, and hemodynamic parameters of right heart catheterization were compared between the two groups. Kaplan-Meier survival analysis was used to evaluate the prognosis of PAD.

Seventeen patients with PAD (mean age ± SD, 38 ± 11 years; 7 men [41.2%]) and 17 patients with PH matched by age and sex were included in the study. Six patients (35.29%) with PAD presented with acute chest pain, and all patients (100%) in PH group presented with chronic symptoms with statistically significant difference (P = 0.018). The diameter ratio of main pulmonary artery to ascending aorta was 2.16 ± 0.81 in PAD group, which was higher than that of PH group (1.48 ± 0.25, P = 0.008). CT imaging of 17 patients of PAD showed intimal flap and the most common was main pulmonary artery involved (n = 13, 76.5%). Pericardial effusion was more common for PAD patients compared with PH (P = 0.031). Patients with PAD may have an increased risk of death compared with PH patients (P = 0.045), and median survival was about 46 months (95%CI: 0-94).

CTPA is valuable in evaluating the intimal flap, extent of the dissection and intraluminal thrombus of PAD. It is necessary to recommend CTPA when patients of PH present with chest pain. Patients with PAD may have an increased risk of death compared with PH patients. The long-term survival outcomes require further investigation with extended follow-up.