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(Circulation. 2003;108:245.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Pulmonary Artery

Stuck Between a Rock and a Hard Place

Frank Grothues, MD; Tobias Welte, MD; Christof Huth, MD; Helmut U. Klein, MD, FESC

From the Department of Cardiology, Angiology, and Pneumology (F.G., T.W., H.U.K.), and Department of Cardiothoracic Surgery (C.H.), Otto-von-Guericke-University, Magdeburg, Germany.

Correspondence to Dr Frank Grothues, Department of Cardiology, Angiology, and Pneumology, Otto-von-Guericke-University, Leipziger Strasse 44, D-39120 Magdeburg, Germany. E-mail frank.grothues@medizin.uni-magdeburg.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

An 82-year-old woman initially presented with left-sided chest and shoulder pain. She was noted to have a large mass on a chest radiograph, but surgical intervention was deemed inappropriate because of her age. Eighteen months later, she complained of increasing shortness of breath at rest and progressive weakness, and a pericardial effusion was discovered. However, it was not possible to determine with either CT or transthoracic echocardiography whether tumor infiltration of the pericardium and great vessels had occurred. Cardiovascular MR (CMR) demonstrated compression of the main pulmonary artery between the huge mass and the ascending aorta, resulting in an impressive slitlike stenotic deformation of the vessel (Figure 1). CMR also showed pericardial thickening of up to 11 mm and tumor infiltration in the lateral and anterolateral region of the heart in the presence of a small pericardial effusion (Figure 2). Subsequently, these CMR findings were confirmed at surgery where partial pericardectomy and total resection of the mass were performed, resulting in pulmonary artery decompression (Figure 3). The patient made an uneventful postoperative recovery. Histology revealed a malignant type IIIb thymoma (World Health Organization classification), an unusual finding in the elderly. In this patient, the ability of CMR to acquire images in any desired plane allowed full evaluation of tumor expansion and was useful in guiding the surgical approach.

View larger version (156K): [in this window] [in a new window]   Figure 1. T1-weighted transverse spin echo image showing the compressed main pulmonary artery (MPA) between the ascending aorta (Ao) and the huge tumor (TU). A pulmonary . . . [Full Text of this Article]