CTICasesExtrinsic Left Main Coronary Compression by Pulmonary Artery Aneurysm
Imaging findings
A young woman with pulmonary hypertension and markedly dilated pulmonary arteries (approximately 7 cm) presented with intermittent chest pain and was being evaluated for possible heart-lung transplant. Catheterization and CT showed extremely critical, near-complete ostial stenosis of the left main coronary artery at its origin, with caliber change during the cardiac cycle, and otherwise entirely clean coronary arteries.
Key takeaways
Massive pulmonary artery dilation from pulmonary hypertension can produce direct extrinsic mass effect on the adjacent left main coronary artery, causing severe compressive stenosis that mimics primary coronary artery disease despite otherwise normal coronaries; this mechanical complication should be considered in young patients with severe pulmonary hypertension and unexplained chest pain or left main stenosis.
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