Neonatal Med.  2020 May;27(2):89-93. 10.5385/nm.2020.27.2.89.

Echogenic Mass Lesion within the Main Pulmonary Artery in a Neonate

• Jeong LE
• Na JY
• Huh J
• Kang IS
• Yang JH
• Jun TG
• Song JY

• KMID: 2503164
• DOI: http://doi.org/10.5385/nm.2020.27.2.89

Abstract

Here we present a rare case of pulmonary arterial thrombosis associated with a ductus arteriosus aneurysm that caused severe pulmonary stenosis. A 5-day-old newborn was admitted to our hospital for the evaluation of an intracardiac mass-like lesion found after the detection of a cardiac murmur. Echocardiography and heart computed tomography revealed a mass-like lesion measuring 8.1 mm in diameter across the distal main pulmonary artery to the proximal left pulmonary artery resulting in localized severe stenosis of the left pulmonary artery. Left pulmonary artery angioplasty for surgical resection of the thrombus revealed that the mass was adherent to the proximal part of the left pulmonary artery anterior wall and extended to the ductus arteriosus. Histological examination of the mass showed an old thrombus with dystrophic calcification. Five months after surgery, follow-up echocardiography showed that the left pulmonary artery peak pressure gradient had decreased but the proximal left pulmonary artery stenosis remained. Cardiac catheterization and balloon angioplasty suc cessfully relieved the pulmonary stenosis.

Keyword

Infant, newborn; Pulmonary artery; Ductus arteriosus

Figure

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  Figure 1. The parasternal short-axis view on transthoracic echocardiography revealed an oval-shaped mass (arrow) protruding from the lumen of the distal main pulmonary artery (MPA) to the proximal left pulmonary artery (LPA) causing LPA stenosis. Abbreviation: RPA, right pulmonary artery.

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  Figure 2. Left pulmonary artery flow velocity estimated by Doppler echocardiography revealed an increased left pulmonary artery pressure.

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  Figure 3. Sagittal (A) and left pulmonary artery (B) views of cardiac computed tomography showing the mass (arrows) in the lumen of the main pulmonary artery. Abbreviations: LA, left atrium; MPA, main pulmonary artery; RV, right ventricle.

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  Figure 4. Intraoperative image showing that the mass (arrow) was tightly attached to the left pulmonary artery anterior wall just below the main pulmonary artery bifurcation. It seemed to extend from the main pulmonary artery bifurcation to the patent ductus arteriosus.

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  Figure 5. Histologic examination of the tissue removed from the left pulmonary artery showing an old thrombus (arrows) with dystrophic calcifications (arrowheads). (A) H&E, ×100; (B) H&E, ×200.

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