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Eur J Cardiothorac Surg 2008;33:112. doi:10.1016/j.ejcts.2007.09.027
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Images in cardio-thoracic surgery

Left atrial isomerism with right pulmonary artery thrombosis

Kuan-Ming Chiu*, Shu-Hsun Chu, Tzu-Yu Lin

Division of Cardiovascular Surgery and Department of Anesthesiology, Far-Eastern Memorial Hospital, Taipei, Taiwan

Received 30 June 2007; received in revised form 6 September 2007; accepted 27 September 2007.

* Corresponding author. Address: Division of Cardiovascular Surgery, Far-Eastern Memorial Hospital, 13F, 21, Sec 2, Nan-Ya S Road, Pan-Chiao, Taipei County 220, Taiwan. Tel.: +886 2 82521414; fax: +886 2 82584395. (Email: kmchius{at}yahoo.com.tw).

Key Words: Left atrial isomerism • Pulmonary artery thrombosis

A 40-year-old woman presented with respiratory distress. Clubbing fingers, hematocrit of 67% and oxygen saturation of 83% were noted. Echocardiography revealed double-outlet right ventricle and transposition of great arteries. Striking images were shown (Fig. 1 ). The pulmonary artery pressure was 55/21 (38) mmHg. Antiplatelet, anticoagulant and regular phlebotomy were prescribed.


Figure 1
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  		Fig. 1. Panel A: Plain chest film shows dextrocardia and symmetric bronchial pattern. (1) Pulmonary artery; (2) aortic arch; (3) azygos arch silhouette. Panel B: Axial computed tomography. (4) Right pulmonary artery aneurysm with thrombus inside; (5) right-side superior vena cava; (6) left-side superior vena cava. Panel C: Frontal reconstruction shows calcified pulmonary artery wall. Panel D: Sagittal reconstruction shows rapid tapering of pulmonary artery aneurysm.

 





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Shu-Hsun Chu
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