Fleischner sign of an enlarged pulmonary artery

Case contributed by Dr Ian Bickle


Chest pain and shortness of breath. Chronic attender.

Patient Data

Age: 65 years
Gender: Female

Cardiomegaly. Prominent pericardial fat pads.

Both pulmonary arteries are enlarged, especially on the right, with the impression of a hilar mass.

Lungs clear.

Case Discussion

The Fleischner sign is a prominent central artery that can be caused either by pulmonary hypertension  or by distension of the vessel by a large pulmonary embolus

In this case it is most evident on the right, although the left is also larger than normal.  This was due to pulmonary hypertension.

This case was investigated for what was misinterpreted as a right hilar mass - CT showed this to be merely and enlarged right pulmonary artery.

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