CTICasesIn Situ Pulmonary Artery Thrombosis in Pulmonary Arterial Hypertension
Imaging findings
Contrast-enhanced CT in a 70-year-old female with pulmonary arterial hypertension demonstrates a markedly dilated main pulmonary artery with atherosclerotic calcifications along its wall. A focal, broad-based filling defect is seen closely adhering to the calcified wall of the pulmonary artery branch, without CT findings of chronic thromboembolic pulmonary hypertension (CTEPH) such as mosaic perfusion, distal vessel pruning, or bronchial artery collateralization.
Key takeaways
In situ pulmonary artery thrombosis is a known complication of long-standing pulmonary arterial hypertension (PAH), occurring due to endothelial dysfunction, sluggish blood flow in dilated vessels, and local atherosclerotic calcification. This must be distinguished from acute thromboembolism and chronic thromboembolic pulmonary hypertension (CTEPH), as management of in situ thrombosis is primarily medical/anticoagulative rather than surgical.
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