Acquired Systemic-to-Pulmonary Artery Transpleural Collateral Vessel Secondary to Pulmonary Embolism.
Radiology. 2019 Jun;291(3):581. doi: 10.1148/radiol.2019190175. Epub 2019 Apr 16.
Chassagnon G1, Revel MP1.
A 63-year-old man presented with atypical chest pain. The patient had been diagnosed with pulmonary embolism 2 years earlier. Thick-slab coronal maximum intensity projection from a contrast material–enhanced CT angiogram of the chest showed the original pulmonary embolus (Figure, a). At follow-up CT 2 years later, a thick-slab coronal maximum intensity projection showed a systemic-to-pulmonary artery collateral vessel (Figure, b). This type of shunt is thought to be related to the development of a transpleural systemic arterial collateral supply to the ischemic lung parenchyma (ie, pulmonary embolism resulting in a pulmonary infarction), as described in patients with chronic pulmonary infection (1). These types of systemic arterial-to-pulmonary artery collateral vessels are true left-to-right arterial shunts and are most commonly seen in patients with congenital cyanotic heart disease (eg, pulmonary atresia) (2). Systemic-to-pulmonary artery collateral vessels are a rare complication of pulmonary embolism and should not be confused with pulmonary sequestration or an arteriovenous malformation.
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