CTICasesAtrial Septal Defect with Pulmonary Artery Aneurysms and Eisenmenger Physiology
Imaging findings
Contrast-enhanced CT shows massive aneurysmal dilation of the main and branching pulmonary arteries with extensive in-situ thrombosis and intimal calcification. A follow-up cardiac MRI reveals a posterior atrial septal defect (ASD) with a Qp/Qs ratio of 1.3 and Eisenmenger physiology, which had previously been missed on transesophageal and transthoracic echocardiography.
Key takeaways
Echocardiography can occasionally fail to detect atrial septal defects (especially sinus venosus or posterior secundum types) due to acoustic window limitations. Cardiac MRI or CT is recommended in patients with unexplained right ventricular enlargement, pulmonary artery aneurysms, or pulmonary hypertension to definitively rule out a shunt.
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