A Case of an Ulcerative Plaque and Disruption of the Main Pulmonary Artery Architecture

Abstract

A 75-year-old Caucasian male with no remarkable past medical history presented to the emergency department complaining of shortness of breath, chest pain, and dyspnea on exertion. His presentation prompted a computed tomography angiogram with reconstruction of the mediastinum (CTPA) and upon review of the image, a splitting or dissection of the main pulmonary artery was seen (Figure 1). This case is unique because it is potentially the first discussion of MPA dissection not due to COPD or CHF but lymphadenopathy caused by neoplasms and great vessel remodeling. Generally, main pulmonary artery (MPA) dissection is seen in patients with congenital heart defects and primary pulmonary hypertension but in this case, lymphoma is viewed as a possible cause due to the patient’s medical history indicating abdominal aorta lymphadenopathy and ulcerative plaques. MPA dissection has been linked to congestive heart failure or COPD in past cases but our patient in this case did not present with any findings linked to those conditions. The patient had little evidence of MPA dissection on prior readings on images done 6 months and 12 months ago– and the current presentation was only discovered incidentally. Our patient was stable and presented with unrelated symptomatology associated with MPA ulceration. It can explain otherwise labeled idiopathic causes of MPA dissection and has the potential to inform physicians and save lives.