J Korean Soc Radiol.  2018 Aug;79(2):97-100. 10.3348/jksr.2018.79.2.97.

CT Findings of Quadricuspid Pulmonary Valve with Pulmonary Artery Aneurysm

• Lee KC
• Yong HS
• Lee JW
• Kang EY

• KMID: 2416395
• DOI: http://doi.org/10.3348/jksr.2018.79.2.97

Abstract

Quadricuspid pulmonary valve (QPV) with pulmonary artery aneurysm is an uncommon condition. QPV is typically clinically silent, so it is often diagnosed after death. However, recent advancements in imaging modalities, such as computed tomography (CT), have allowed more frequent incidental diagnosis of QPV in living adults. We report a case of QPV with pulmonary artery aneurysm in an asymptomatic adult; the condition was detected by CT aortography but was not discernible in echocardiography. Following the case presentation, we review the prior related literature.

MeSH Terms

Adult
Aneurysm*
Aortography
Congenital Abnormalities
Diagnosis
Echocardiography
Humans
Pulmonary Artery*
Pulmonary Valve*
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 These figures show QPV with pulmonary artery aneurysm. A. Chest radiography shows bulging opacity in the left hilum, probably due to prominent vascular shadow B, C. Double oblique reconstruction CT image shows QPV (arrow, B) and normal tricuspid AV (arrowhead, C). D. Axial CT image shows dilated pulmonary artery, suggesting pulmonary artery aneurysm. AV = aortic valve, QPV = quadricuspid pulmonary valve

• 

  Fig. 2 This figure shows embryogenesis of QPV and normal tricuspid AV. Abnormal mesenchymal proliferation is the first step leading to QPV. AV = aortic valve, QPV = quadricuspid pulmonary valve

Reference

1. Hurwitz LE, Roberts WC. Quadricuspid semilunar valve. Am J Cardiol. 1973; 31:623–626.

2. Nollen GJ, Kodde J, Beek AM, Res JC, van Rossum AC. Quadricuspid pulmonary valve and left pulmonary artery aneurysm in an asymptomatic patient assessed by cardiovascular MRI. Neth Heart J. 2013; 21:196–198.

3. Jung SY. Quadricuspid pulmonary valve in an adult patient identified by transthoracic echocardiography andmulti-detector computed tomography. Hellenic J Cardiol. 2015; 56:266–268.

4. Hirooka K, Hashimoto S, Tanaka N, Yamada N, Masuda Y, Hanatani A, et al. Combined abnormalities of semilunar valves quadricuspid pulmonary and bicuspid aortic valves. Circulation. 2001; 103:E7.

5. Jashari R, Van Hoeck B, Goffin Y, Vanderkelen A. The incidence of congenital bicuspid or bileaflet and quadricuspid or quadrileaflet arterial valves in 3,861 donor hearts in the European Homograft Bank. J Heart Valve Dis. 2009; 18:337–344.

6. Deterling RA Jr, Clagett OT. Aneurysm of the pulmonary artery: review of the literature and report of a case. Am Heart J. 1947; 34:471–499.

7. Shih HH, Kang PL, Lin CY, Lin YH. Main pulmonary artery aneurysm. J Chin Med Assoc. 2007; 70:453–455.

8. Gentille Lorente DI. The pulmonary valve and the pulmonary artery. Eur Heart J. 2009; 30:2326.

9. Akerem Khan SK, Anavekar NS, Araoz PA. Quadricuspid pulmonary valve computed tomography case series and review of relevant literature. J Thorac Imaging. 2012; 27:W171–W173.

10. Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol. 2015; 16:251–285.