CASE-REPORT - EXTENSIVE PULMONARY AND AORTIC THROMBOSIS AND ECTASIA

Progressive shortness of breath developed in an elderly woman with a 2 5-year history of recurrent superficial phlebitis and hemoptysis, Exte nsive mural thrombosis and ectasia of the large and medium-sized pulmo nary arteries and aorta were revealed on echocardiography and computer ized tomography. The patient died 2 months later. On autopsy, the gros s morphologic findings were similar with those observed by imaging, Hi stologically, there was mild inflammation in the intima and media of t he aorta and the large pulmonary arteries, consistent with nonspecific arteritis, The extensive thrombosis and ectasia of the pulmonary arte ries and aorta differ from previously published cases and cannot be as signed to a known nosologic entity. Two alternative explanations are p roposed. First, an endothelial disorder was responsible for a diffuse vasculopathy that involved veins, pulmonary arteries, and aorta. Secon d, a vasculopathy of the Hugh-Stovin type, characterized by phlebitis and pulmonary thromboembolism, caused pulmonary hypertension and low c ardiac output. The low flow state favorized aortic thrombosis and, at the site of interaction between the clot and the arterial wall, arteri tis developed as an epiphenomenon, which induced arterial dilatation. Combined idiopathic pulmonary artery and aortic thrombosis and ectasia is rare and calls for corroboration of sporadic observations such as the current one.