Presentation
Chest pain with shortness of breath.
Patient Data
The chest radiographs show volume loss of the right lung with elevated right hemidiaphragm, reduced intercostal spaces, decreased vascular markings and no visualization of the right pulmonary artery shadow. The left lung shows prominent vascular markings with no volume loss.
The CT images reveal an interruption of the right pulmonary artery 1.5 cm from the bifurcation (a pericardial recess is seen at the site of interruption). Multiple systemic collaterals are observed supplying the right lung. There is dilatation of the main and left pulmonary arteries, as well as the lobar and segmental branches. Multiple intraluminal filling defects are seen within the left lobar arteries as well as their segmental and subsegmental branches.
Lung window shows decreased volume and vascular markings of the right lung as compared to the left. Interstitial changes of the right lower lobe with mild bronchial dilatation of the lung base. Note the prominent vascular markings of the left lung with mosaic perfusion pattern in the upper lobe.
Case Discussion
The mortality rate from pulmonary embolism is higher in a patient with contralateral agenesis of the pulmonary artery.
In such case, the differential diagnosis for the right lung findings is a chronic pulmonary embolism.
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