CTICasesEisenmenger Syndrome with Giant Pulmonary Artery Aneurysm Secondary to Secundum Atrial Septal Defect
Imaging findings
Chest radiograph reveals massive cardiomegaly and giant enlargement of the main and central pulmonary arteries with prominent peripheral tapering and curvilinear calcification. CT shows a massive secundum-type atrial septal defect, severe main pulmonary artery dilation measuring nearly seven centimeters, extensive mural calcification (indicative of pulmonary atherosclerosis), and a small-caliber aorta due to chronically reduced systemic forward cardiac output.
Key takeaways
This case represents a classic imaging presentation of Eisenmenger syndrome resulting from a long-standing, unrepaired secundum atrial septal defect. Chronic left-to-right shunting leads to severe, irreversible pulmonary vascular disease and subsequent right-to-left shunting (Eisenmenger physiology). Giant pulmonary artery aneurysms in this setting frequently exhibit heavy atherosclerosis and in-situ mural thrombus, and can carry risks of dissection, rupture, or mechanical compression of adjacent structures such as the left main coronary artery.
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