Central pulmonary artery lesions in chronic obstructive pulmonary disease - A transesophageal echocardiography study

Background-In patients with acute pulmonary embolism, transesophageal echoc ardiography (TEE) often reveals presumably thrombotic lesions within the ce ntral pulmonary arteries (CPAs). These CPA lesions, when found in patients with primary pulmonary hypertension, have been attributed to in situ thromb osis or atherosclerosis. We hypothesized that similar CPA lesions may also develop in patients with chronic obstructive pulmonary disease(COPD) in the absence of pulmonary embolism. Methods and Results-We examined by TEE 25 patients with COPD and 27 control patients with left heart disease. None of the patients had previous pulmon ary embolism or ileofemoral and popliteal Vein thrombosis. By use of TEE, C PA lesions were found in 12 COPD patients (48%) and 27 control patients (7. 4%) (P<0.01), When CPA lesions were subdivided into types 1 (protruding and mobile) and 2 (wall-adherent), type 1 lesions proved to be uncommon, being found within the pulmonary trunk in 12% and 3.7% of COPD and control patie nts, respectively (P=NS). Conversely, type 2 lesions, which were always loc alized in the right pulmonary artery, were frequent in COPD patients (36%) and rare in control patients (3.7%) (P<0.01). When available, helical CT an d MR angiography confirmed TEE findings, supporting an atherosclerotic orig in of type 2 lesions, which were different from typical thrombotic lesions. FEV1/FVC ratio, RV/TLC ratio, PaO2, hematocrit value, and pulmonary artery systolic pressure were not significantly different in COPD patients with a nd without CPA lesions. At TEE, however, COPD patients with CPA lesions sho wed a larger size of the main and right pulmonary arteries. Conclusions-TEE often reveals CPA lesions in stable patients with COPD even in the absence of significant pulmonary hypertension and not in close rela tion with the severity of pulmonary dysfunction.