CTICasesAcquired Systemic-to-Pulmonary Arterial Collaterals from Chronic Lupus Pleuritis
Imaging findings
In a young woman with lupus, CT shows numerous small, tortuous vessels arising from the internal mammary arterial system and coursing through the extrapleural tissues and chest wall, anastomosing with the right middle lobe pulmonary artery through a large feeding vessel; the adjacent pleural surface is thickened and nodular, and similar, less prominent abnormal vessels are present from the left internal mammary system.
Key takeaways
Numerous small systemic-to-pulmonary arterial collaterals arising from the internal mammary system and crossing an inflamed, thickened pleural surface -- rather than one large anomalous vessel -- represent an acquired neovascular process, most plausibly related to chronic lupus pleuritis irritating the pleura and recruiting systemic collaterals, rather than a congenital sequestration-type anomaly.
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