J Cardiovasc Ultrasound.  2014 Dec;22(4):209-212. 10.4250/jcu.2014.22.4.209.

Pulmonary Artery Stenosis due to Lung Carcinoma: A Rare Cause of Dyspnea

• Kharwar RB
• Sharma A
• Sethi R
• Narain VS
• Saran RK

• KMID: 1980425
• DOI: http://doi.org/10.4250/jcu.2014.22.4.209

Abstract

Acquired bilateral pulmonary artery stenosis in adults due to lung malignancy is infrequently reported. We describe an adult male who presented to us with chief complaints of dyspnea on exertion and one episode of hemoptysis. Two dimensional transthoracic echocardiography with color Doppler showed presence of an extra cardiac mass causing severe extrinsic compression of both the right and left pulmonary artery leading to high pressure severe tricuspid regurgitation and extension of the mass into the left atrium. Three dimensional transthoracic echocardiography clearly delineated the anatomy of the left atrial mass and its surrounding anatomical relationship. The diagnosis of non small cell lung carcinoma was confirmed by multidetector computed tomography (MDCT) and with MDCT guided biopsy with histopathology. Patient succumbed one month later due to an episode of massive hemoptysis.

Keyword

Lung carcinoma; Pulmonary artery stenosis; Three dimensional echocardiography

MeSH Terms

Adult
Biopsy
Carcinoma, Non-Small-Cell Lung
Constriction, Pathologic*
Diagnosis
Dyspnea*
Echocardiography
Echocardiography, Three-Dimensional
Heart Atria
Hemoptysis
Humans
Lung*
Male
Multidetector Computed Tomography
Pulmonary Artery*
Tricuspid Valve Insufficiency

Figure

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  Fig. 1 Chest X-ray PA view showing an opaque shadow in the upper and middle zone of the left lung which is inseparable from the cardiac silhoute. Also note that the left hemi-diaphragm is higher than the right hemi-diaphragm.

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  Fig. 2 Two dimensional transthoracic echocardiography with color Doppler. The parasternal long axis view (A) is showing a mass in the left atrium. The extracardiac mass (indicated by *) is seen to involve the region of the MPA and right and the left pulmonary artery region in the basal short axis view (B). Severe tricuspid regurgitation is seen in the apical four chamber view (C) with a peak TR velocity of 4.2 m/sec on continous wave Doppler (D). Ao: aorta, LA: left atrium, LV: left ventricle, MPA: main pulmonary artery, RV: right ventricle, TR: tricuspid regurgitation, RPA: right pulmonary artery.

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  Fig. 3 Two dimensional transthoracic echocardiography with color Doppler. The basal short axis (A) view with focus on the pulmonary artery showing severe turbulence in RPA and LPA caused by extrinsic compression of a huge mass. Three dimensional transthoracic echocardiography showing stenotic right pulmonary artery caused by the extrinsic compression by the mass (B) and the surface characteristics and anatomical relationship of the intra atrial extension of the mass (indicated by * in C and D). Ao: aorta, LA: left atrium, LPA: left pulmonary artery, RA: right atrium, RPA: right pulmonary artery.

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  Fig. 4 Multidetector computed tomography with contrast showing a large mass (indicated by *) in the upper left pulmonary zone encroaching upon and causing severe extrinsic compression of the RPA and LPA as shown in the axial sections (A and B). The mass has infiltrated into the left atrium in the form of a pedunculated growth as seen in the axial section (C) and in the coronal section (D). AA: ascending aorta, DA: descending aorta, LA: left atrium, LPA: left pulmonary artery, RPA: right pulmonary artery, MPA: main pulmonary artery.

Reference

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