Clinical communicationA case of pulmonary artery dissection diagnosed in the Emergency Department1
Introduction
Pulmonary artery dissection is a rare but life-threatening disease, as sudden death typically results when the main pulmonary artery dissects into the pericardium causing acute cardiac tamponade 1, 2, 3, 4. The pulmonary artery may also dissect into the lung parenchyma or into the bronchial tree 3, 5.
Clinical presentation of a pulmonary artery dissection typically involves chest pain, central cyanosis, exertional dyspnea, and sudden hemodynamic decompensation in a previously stable patient with known risk factors or a known pulmonary artery aneurysm (6). Most cases of pulmonary artery dissection are diagnosed at autopsy. The following is a report of pulmonary artery dissection diagnosed in the ED with bedside echocardiography.
Section snippets
Case report
A 42-year-old man presented to the Emergency Department (ED) with the complaint of right-sided chest and neck pain for approximately 1 h. The patient described the pain as a tightness, and rated it at 7 out of 10 in severity. The pain radiated to his neck and left arm. The patient denied ever experiencing the pain before. The pain was not related to exertion and was not alleviated by rest. The patient denied any associated shortness of breath, diaphoresis, nausea, abdominal pain, or weakness of
Discussion
Dissection of the pulmonary artery is a rare but life-threatening disease that typically occurs at the site of a pulmonary artery aneurysm associated with pulmonary hypertension or connective tissue disease (1). In a necropsy review of 111 cases of pulmonary artery aneurysms, pulmonary hypertension because of cardiac malformation was present in 74 (66%) patients (7). Patent ductus arteriosus was the most common single cardiac lesion, occurring in combination with 23% of pulmonary artery
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Cited by (22)
Pulmonary artery dissection in a patient with undiagnosed pulmonary hypertension - A case report and review of literature
2015, Heart and Lung: Journal of Acute and Critical CareSudden death due to dissection of the thoracic aorta associated with dissection and rupture of the pulmonary artery: Report of two cases
2014, Forensic Science InternationalGiant pulmonary artery aneurysm with dissection in a case of marfan syndrome
2013, Journal of the American College of CardiologyPulmonary artery dissection mimicking mediastinal mass
2009, Heart and Lung: Journal of Acute and Critical CareCitation Excerpt :Dissection and rupture into the mediastinum, bronchial tree, and obstruction of the pulmonary vascular lumen have also been reported.6 Signs and symptoms of PAD are unspecific; however, the most commonly reported are chest pain, dyspnea on exertion, central cyanosis, hemoptysis, and hemodynamic decompensation.5,7,8 There may be a time interval between the onset of chest pain and the dissection into the pericardium, varying between 2 and 14 days.6
Pulmonary MR Angiography Techniques and Applications
2009, Magnetic Resonance Imaging Clinics of North AmericaCitation Excerpt :Pulmonary artery dissection is an extremely rare event that occurs in the setting of aneurysmal dilatation of the pulmonary arteries from chronic pulmonary hypertension. The large majority of patients undergo sudden death from rupture into the pericardium leading to acute tamponade, with the diagnosis made at autopsy.119 In recent years, there have been an increasing number of reports of patients surviving the initial event, with a number of surgical approaches attempted as treatment.120
Pulmonary artery dissection and rupture associated with aortopulmonary window
2004, Annals of Thoracic SurgeryCitation Excerpt :Congenital malformations are mostly responsible for secondary pulmonary hypertension [3], but it has been observed in hereditary disorders [4], acquired valvular lesion, and chronic pulmonary diseases (tuberculosis and syphilis) [1]. According to the literature [1–6], dissection always occurs at the site of maximal dilatation of the artery. In contrast to aortic dissection and because of the thinness and fragility of the external layer, the high pressure inside the false lumen tends to favor rupture of the free wall rather than tearing the intimal flap and opening a reentry site.
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Clinical Communications is coordinated by Ron Walls, MD, of Brigham and Women’s Hospital and Harvard University Medical School, Boston, Massachusetts