Presentation
Supraventricular tachycardia on ECG for investigation
Patient Data
Heart size is enlarged. Bilateral pulmonary arteries are enlarged.
Patchy opacities at both lung fields.
Poor contrast opacification from this CTPA study. There is a mixture of contrasted and non-contrasted blood within the pulmonary arteries.
Suspicious communication from the aortic arch to the pulmonary artery.
Good pulmonary arteries opacification from CT angiogram of thoracic aorta. Previous suspicious communication is clearly seen, in which is the patent ductus arteriosus.
Case Discussion
This patient present with cardiomegaly and large bilateral pulmonary arteries on chest radiograph. It was further investigated for pulmonary embolism, in which CTPA was performed. CTPA shows poor contrast opacification of pulmonary vessels (likely due to mixture of contrasted and non-contrasted blood). There is also suspicious communication at aorta and pulmonary arteries. CTA thoracic aorta was performed which confirm the presence of patent ductus arteriosus. The contrast from the aorta clearly flow into the pulmonary artery system, in which opacifies the pulmonary arteries.
The arterial circulation is still higher pressure compared to pulmonary arterial circulation in this case. Eisenmenger phenomenon still did not occur in this patient (which pulmonary artery circulation is higher pressure compared to arterial circulation).
This patient likely have Krichenko classification type B (window, short and wide ductus with blending of pulmonary artery).