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CT Angiography of Pulmonary Artery Aneurysms in Hughes-Stovin Syndrome

¹ Department of Radiology, Thoracic and Cardiovascular Imaging Sections, Stanford University Medical Center, 300 Pasteur Dr., Rm. S-072, Stanford, CA 94305-5105.
² Department of Medicine, Vera Moulton Wall Center for Pulmonary Vascular Disease, Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, CA.

View larger version (126K): [in a new window]   Fig. 1A —49-year-old man who presented to emergency department with acute pleuritic chest pain and shortness of breath on exertion in August 2003. Medical history was significant for May 2001 bypass surgery for spontaneous left posterior tibial artery pseudoaneurysm, December 2002 diagnosis of right thigh and calf deep venous thrombosis, June 2003 admission for fever and hemoptysis, and late July 2003 diagnosis of bilateral pulmonary emboli during admission for high fever and aching chest pain. Pulmonary CT angiographic images obtained in August 2003 show wall-adherent soft-tissue-density filling defects in right lower lobe pulmonary artery (arrow, A) and in left pulmonary artery (arrowhead, B). Note subtle rim of enhancement at periphery of presumed endoluminal thrombus.

View larger version (113K): [in a new window]   Fig. 1B —49-year-old man who presented to emergency department with acute pleuritic chest pain and shortness of breath on exertion in August 2003. Medical history was significant for May 2001 bypass surgery for spontaneous left posterior tibial artery pseudoaneurysm, December 2002 diagnosis of right thigh and calf deep venous thrombosis, June 2003 admission for fever and hemoptysis, and late July 2003 diagnosis of bilateral pulmonary emboli during admission for high fever and aching chest pain. Pulmonary CT angiographic images obtained in August 2003 show wall-adherent soft-tissue-density filling defects in right lower lobe pulmonary artery (arrow, A) and in left pulmonary artery (arrowhead, B). Note subtle rim of enhancement at periphery of presumed endoluminal thrombus.

View larger version (125K): [in a new window]   Fig. 1C —49-year-old man who presented to emergency department with acute pleuritic chest pain and shortness of breath on exertion in August 2003. Medical history was significant for May 2001 bypass surgery for spontaneous left posterior tibial artery pseudoaneurysm, December 2002 diagnosis of right thigh and calf deep venous thrombosis, June 2003 admission for fever and hemoptysis, and late July 2003 diagnosis of bilateral pulmonary emboli during admission for high fever and aching chest pain. Follow-up pulmonary CT angiographic images obtained in December 2003 show interval development of pulmonary artery aneurysms at sites of prior thrombus in right lower lobe segmental branch (arrow, C) and in superior segment of left lower lobe artery (arrowhead, D).

View larger version (116K): [in a new window]   Fig. 1D —49-year-old man who presented to emergency department with acute pleuritic chest pain and shortness of breath on exertion in August 2003. Medical history was significant for May 2001 bypass surgery for spontaneous left posterior tibial artery pseudoaneurysm, December 2002 diagnosis of right thigh and calf deep venous thrombosis, June 2003 admission for fever and hemoptysis, and late July 2003 diagnosis of bilateral pulmonary emboli during admission for high fever and aching chest pain. Follow-up pulmonary CT angiographic images obtained in December 2003 show interval development of pulmonary artery aneurysms at sites of prior thrombus in right lower lobe segmental branch (arrow, C) and in superior segment of left lower lobe artery (arrowhead, D).

View larger version (102K): [in a new window]   Fig. 1E —49-year-old man who presented to emergency department with acute pleuritic chest pain and shortness of breath on exertion in August 2003. Medical history was significant for May 2001 bypass surgery for spontaneous left posterior tibial artery pseudoaneurysm, December 2002 diagnosis of right thigh and calf deep venous thrombosis, June 2003 admission for fever and hemoptysis, and late July 2003 diagnosis of bilateral pulmonary emboli during admission for high fever and aching chest pain. Volume-rendered images (posterior views) of pulmonary arteries from August 2003 that correspond to pulmonary angiograms obtained at same time (A and B) show increased vascularity surrounding left pulmonary artery at origin of superior segment of left lower lobe branch (arrowhead, E) and in right lower lobe (arrow, F).

View larger version (93K): [in a new window]   Fig. 1F —49-year-old man who presented to emergency department with acute pleuritic chest pain and shortness of breath on exertion in August 2003. Medical history was significant for May 2001 bypass surgery for spontaneous left posterior tibial artery pseudoaneurysm, December 2002 diagnosis of right thigh and calf deep venous thrombosis, June 2003 admission for fever and hemoptysis, and late July 2003 diagnosis of bilateral pulmonary emboli during admission for high fever and aching chest pain. Volume-rendered images (posterior views) of pulmonary arteries from August 2003 that correspond to pulmonary angiograms obtained at same time (A and B) show increased vascularity surrounding left pulmonary artery at origin of superior segment of left lower lobe branch (arrowhead, E) and in right lower lobe (arrow, F).

View larger version (91K): [in a new window]   Fig. 1G —49-year-old man who presented to emergency department with acute pleuritic chest pain and shortness of breath on exertion in August 2003. Medical history was significant for May 2001 bypass surgery for spontaneous left posterior tibial artery pseudoaneurysm, December 2002 diagnosis of right thigh and calf deep venous thrombosis, June 2003 admission for fever and hemoptysis, and late July 2003 diagnosis of bilateral pulmonary emboli during admission for high fever and aching chest pain. Volume-rendered images (posterior views) of pulmonary arteries from December 2003 that correspond to pulmonary angiograms obtained at same time (C and D) show pulmonary artery aneurysms (arrowhead, G; arrow, H) in same anatomic locations as in other December 2003 images (C and D). Note fine web of bronchial artery vessels surrounding aneurysms.

View larger version (85K): [in a new window]   Fig. 1H —49-year-old man who presented to emergency department with acute pleuritic chest pain and shortness of breath on exertion in August 2003. Medical history was significant for May 2001 bypass surgery for spontaneous left posterior tibial artery pseudoaneurysm, December 2002 diagnosis of right thigh and calf deep venous thrombosis, June 2003 admission for fever and hemoptysis, and late July 2003 diagnosis of bilateral pulmonary emboli during admission for high fever and aching chest pain. Volume-rendered images (posterior views) of pulmonary arteries from December 2003 that correspond to pulmonary angiograms obtained at same time (C and D) show pulmonary artery aneurysms (arrowhead, G; arrow, H) in same anatomic locations as in other December 2003 images (C and D). Note fine web of bronchial artery vessels surrounding aneurysms.

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