Pulmonary valvular stenosis - Chen sign and post stenotic dilatation of the left pulmonary artery
Presentation
Pre cardiology workup for systolic murmur.
Patient Data
The patient is rotated to the right. The left pulmonary artery is grossly enlarged. The right pulmonary artery and hilum appear normal. The peripheral pulmonary arteries are more prevalent in the left base compared to the right (Chen sign). Heart size is normal. The lungs and pleural surfaces are clear. No signs of pulmonary edema.
Case Discussion
Cardiology workup diagnosed pulmonary valve stenosis due to congenital bicuspid valvular anatomy.
Chen sign is described as the prominence of left basal pulmonary vasculature compared to the right base due to the asymmetric increase in pulmonary blood flow to the left lung. It is secondary to preferential blood flow into the left pulmonary artery after passing through the stenosed pulmonary valve during systole.
Enlargement of the left pulmonary artery is secondary to the same effect, causing post stenotic dilatation.
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