CTICasesIsolated Main Pulmonary Artery Aneurysm from a Quadricuspid Pulmonic Valve
Imaging findings
In an asymptomatic 53-year-old woman, imaging obtained for an unrelated PE workup incidentally shows an aneurysmal main pulmonary artery, isolated to the main segment without involvement of the left or right pulmonary arteries, with mild right atrial and ventricular dilation; segmental pulmonary arteries are normal in caliber. Multiplanar CT reformats subsequently demonstrate a thickened, quadricuspid pulmonic valve.
Key takeaways
An isolated main pulmonary artery aneurysm without segmental artery enlargement or right ventricular hypertrophy to suggest pulmonary hypertension should prompt close evaluation of the pulmonic valve -- here, a quadricuspid pulmonic valve, an uncommon valve anomaly analogous to a bicuspid aortic valve, was found to be the likely underlying cause via associated post-stenotic-type dilation and wall abnormality, rather than the aneurysm being a truly idiopathic finding.
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