Aneurysmal dilatation of the pulmonary trunk with mild pulmonic stenosis

We present the unusual case of a 72-year-old woman whose chest X-ray showed an abnormal left hilar shadow. A pulmonary angiogram revealed an aneurysm in the pulmonary artery with a diameter of 55 mm that extended from the main pulmonary trunk to its bifurcation. Mild pulmonic stenosis with a systolic pressure gradient of 18 mmHg across the pulmonic valve was recognized. Mild dilatation of the ascending aorta was also present. The pressure gradient across the pulmonic valve was lower than is typical for an aneurysmal dilatation, suggesting that this patient represented a case of idiopathic pulmonary artery dilatation. We suspected the presence of a congenital structural alteration common to the pulmonary artery and the ascending aorta.