Presentation
Acute right-sided pleuritic pain and breathlessness. High D-dimer.
Patient Data
Severe luminal narrowing (maximal 4 mm caliber) of the right main pulmonary artery, due to severe concentric mural thickening, such that only a thin trickle of contrast passes through.
Right upper and lower lobar pulmonary arteries are completely opacified by low density material. Right middle lobe pulmonary artery is narrowed proximally.
Mild mural thickening of the distal ascending aorta and aortic arch. Marked mural thickening of the brachiocephalic trunk, right subclavian and bilateral common carotid arteries. Non-opacified left subclavian artery.
Left main pulmonary artery and its lobar and more distal branches opacify normally
with no evidence of left-sided PE. No pulmonary arterial or cardiac enlargement. No involvement of the venae cavae or other major veins (as far as can be seen on this angiographic study).
Lungs clear.
Partially imaged upper abdominal appearances are unremarkable.
No suspicious bone lesions.
Conclusion:
Severe mural thickening of the main right pulmonary artery, and non-opacified RUL/RLL arteries. Superadded thrombosis may be present. Less marked mural thickening of the aortic arch and its main branches. Appearances consistent with a large vessel vasculitis. No evidence of an acute pulmonary embolus.
Case Discussion
Appearances are consistent with a large vessel vasculitis, and this patient had had a biopsy performed elsewhere confirming Takayasu arteritis.