CTICasesChronic Thromboembolic Pulmonary Hypertension (CTEPH) with Pulmonary Artery Compression of Left Coronary Artery
Imaging findings
Chest CT demonstrates massively enlarged central pulmonary arteries with calcified walls (atheromatous from chronic pulmonary hypertension), extensive mural thrombus, and a left coronary artery stent. The left coronary artery is markedly compressed between the enlarged main pulmonary artery and the aorta, explaining the patient's presentation with myocardial infarction and ischemic cardiomyopathy.
Key takeaways
Massive pulmonary artery enlargement from chronic pulmonary hypertension (including CTEPH) can extrinsically compress the left main coronary artery between the main pulmonary artery and the aortic root, causing ischemic heart disease independent of atherosclerosis. CT angiography can directly demonstrate this compression and is an important finding that may require coronary stenting in addition to pulmonary hypertension management.
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