CTICasesFontan Physiology with LPA Embolization and Systemic Collaterals
Imaging findings
CT angiography in a patient with Fontan physiology shows embolization coils in the left pulmonary artery (LPA). There is massive, dilated systemic arterial collateral recruitment from the intercostal and internal mammary arteries supplying the left lung, bypassing the embolized segment.
Key takeaways
In patients with Fontan circulation, high systemic venous pressures promote the development of systemic-to-pulmonary venous or arterial shunts. If a pulmonary artery segment is embolized, the low-resistance lung tissue recruits extensive systemic arterial collaterals, which can lead to hemoptysis or volume overload.
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