Pulmonary artery obstruction; report of a case with angiocardiographic demonstration.

Abstract

The purpose of this paper is to report a case of incomplete obstruction of the left pulmonary artery demonstrated during life by angiocardiography. Reviews of the literature pertaining to thrombosis of the main pulmonary artery and its right and left branches were made by Kampmeier (1) in 1934 and by Savacool and Charr (2) in 1941. The latter authors summarized 100 reported cases, including their own, and found the preponderant site to be the right pulmonary artery. In 46 per cent of the cases, the thrombosis was associated with parenchymal pulmonary disease. Pathological conditions which were associated with the thrombosis were tuberculosis, mitral stenosis, aortic valvular disease, congenital heart disease, and embolism from the peripheral veins. Anthracosilicosis, emphysema, fibrosis, lung abscess, jaundice, possible syphilis of the pulmonary artery, chronic purulent bronchitis, pulmonary atherosclerosis, bronchiectasis, bronchopneumonia, empyema, and pulmonary carcinoma were among other diseases present. Tuberculosis has been mentioned by several writers as a frequent cause of pulmonary artery occlusion (3–5). The predominant clinical findings in the reported cases were progressive dyspnea, cough, chest pain, hemoptysis, restlessness, exophthalmos, low pulse pressure with thready pulse, and edema of the lower extremities. The onset may be acute, but occasionally no symptoms are present until evidence of right heart failure ensues. In many of the cases collected by Savacool and Charr there was evidence of right heart enlargement, which we feel indicated the presence of cor pulmonale. This may be a result of the existing pulmonary disease but may have occurred as a consequenee of pulmonary artery occlusion. Although most of the cases of pulmonary artery occlusion were found after death, the condition is not incompatible with life, when either the right or the left or even the main pulmonary artery is involved (Desclin and Regnier, 6). The diagnosis, therefore, is an important clinical consideration. The roentgenographic study of the pulmonary circulation and obstruction of the pulmonary artery or its branches includes the use of plain films, fluoroscopy, and opaque studies. The changes which are demonstrable by these methods will be described in the discussion. Case Report T. B., a 54-year-old single white female, entered the clinic complaining of soreness through her stomach and bowels for three and a half years. She had spells of vomiting upon arising in the morning, but this did not seem to be influenced by what she ate. There had been no melena, chills, fever, or colic. Associated complaints were bloating, belching, flatus, and irregular bowel habits, constipation alternating with frequent loose stools.