CTICasesMassive In-Situ Pulmonary Artery Thrombus in Chronic Pulmonary Hypertension
Imaging findings
A patient with long-standing pulmonary hypertension, previously without filling defects and with a reportedly normal VQ scan, now has extensive eccentric wall-adherent thrombus in the pulmonary arteries with some distal filling defects that may be acute or subacute. There are subacute hemorrhagic infarcts throughout, pleural effusions, and a markedly dilated, thickened right ventricle. The material is smoothly adherent to the vessel wall rather than frond-like.
Key takeaways
Severe long-standing pulmonary hypertension can develop exuberant in-situ pulmonary artery thrombus, distinguished from pulmonary artery sarcoma by its smooth, wall-adherent, lentiform shape (bilateral here) rather than the frond-like filling of sarcoma, with MRI helpful in equivocal cases. Whether such patients form chronic thromboembolic disease from shed thrombus or develop it independently is unresolved, but the bilateral wall-conforming morphology and clinical context favored bland thrombus over tumor.
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