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      Spontaneously Developed Pulmonary Arterial Intramural Hematoma That Mimicked Thromboembolism

      , MD1, , MD, PhD1, , MD2, , MD, PhD3, , MD, PhD4, , MD, PhD5, , MD, PhD2

      Korean Journal of Radiology

      The Korean Society of Radiology

      Pulmonary artery, Intramural hematoma, CT, Ultrasound

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          Abstract

          A 65-year-old woman visited our hospital with a complaint of acute onset dyspnea and radiological manifestations of pulmonary thromboembolism. The patient underwent an exploratory surgery to find a whitish-blue colored mass occupying almost the whole lumen of the main pulmonary arteries. Based on the pathological and radiological findings, the patient was diagnosed to have a pulmonary arterial intramural hematoma. Intramural hematomas are usually observed in the walls of the aorta, and we believe that an isolated intramural hematoma in the pulmonary artery has not been described previously.

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          Most cited references 6

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          The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis.

          Criteria for the classification of Takayasu arteritis were developed by comparing 63 patients who had this disease with 744 control patients with other forms of vasculitis. Six criteria were selected for the traditional format classification: onset at age less than or equal to 40 years, claudication of an extremity, decreased brachial artery pulse, greater than 10 mm Hg difference in systolic blood pressure between arms, a bruit over the subclavian arteries or the aorta, and arteriographic evidence of narrowing or occlusion of the entire aorta, its primary branches, or large arteries in the proximal upper or lower extremities. The presence of 3 or more of these 6 criteria demonstrated a sensitivity of 90.5% and a specificity of 97.8%. A classification tree also was constructed with 5 of these 6 criteria, omitting claudication of an extremity. The classification tree demonstrated a sensitivity of 92.1% and a specificity of 97.0%.
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            Dissecting aneurysm of the pulmonary artery with pulmonary hypertension.

            Pulmonary artery dissection was observed in a 64-yr-old female patient with severe pulmonary hypertension, which was probably primary (pulmonary vascular resistance, 817 dyn.s.cm-5; normal range less than or equal to 200 dyn.s.cm-5). The patient was admitted to the hospital because of severe dyspnea on exertion. Echocardiography demonstrated a dissecting aneurysm of the pulmonary artery. Right heart catheterization revealed severe pulmonary hypertension (mean pulmonary artery pressure, 64 mm Hg; normal range, 10 to 22 mm Hg); dissection of the pulmonary artery was confirmed by pulmonary arteriography. One-year follow-up was uneventful. In the literature, 28 patients with dissecting aneurysm of the pulmonary artery are reviewed. The dissection has only been diagnosed in life in one patient (by echocardiography).
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              Dissecting aneurysm of the pulmonary trunk in mitral stenosis.

               R Rosenson,  M. Sutton (1986)
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                Author and article information

                Affiliations
                [1]Department of Radiology, Dong-A University College of Medicine, Busan 602-714, Korea.
                [2]Department of Radiology, Kyungpook National University Hospital, Daegu 700-721, Korea.
                [3]Department of Pathology, Kyungpook National University Hospital, Daegu 700-721, Korea.
                [4]Department of Thoracic Surgery, Kyungpook National University Hospital, Daegu 700-721, Korea.
                [5]Department of Cardiology, Kyungpook National University Hospital, Daegu 700-721, Korea.
                Author notes
                Corresponding author: Jongmin Lee, MD, PhD, Department of Radiology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 700-721, Korea. Tel: (8253) 420-5390, Fax: (8253) 422-2677, jonglee@123456knu.ac.kr
                Journal
                Korean J Radiol
                Korean J Radiol
                KJR
                Korean Journal of Radiology
                The Korean Society of Radiology
                1229-6929
                2005-8330
                Jul-Aug 2012
                18 June 2012
                : 13
                : 4
                : 496-499
                3384833
                22778573
                10.3348/kjr.2012.13.4.496
                Copyright © 2012 The Korean Society of Radiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Case Report

                Radiology & Imaging

                ct, intramural hematoma, ultrasound, pulmonary artery

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