IMAGES IN CARDIOLOGY
Aortopulmonary Artery Dissection
Hideki Itoh, MD,* Takashi Yamamoto, MD,* Hiroyuki Sugihara, MD,† Takao Saotome, MD,‡
Yutaka Eguchi, MD,‡ Tohru Asai, MD,§ Minoru Horie, MD*
From the Departments of
†Pathology, ‡Critical and
Intensive Care Medicine,
and §Surgery, Shiga
University of Medical
Science, Shiga, Japan.
February 13, 2009,
accepted February 18, 2009.
continuous hydration for renal dysfunction and severe metabolic acidosis (base excess of –16.5
mmol/l and pH of 7.24) and underwent enhanced chest computed tomography. The chest
computed tomography showed not only ascending aortic dissection of Stanford type A but also
pulmonary artery dissection with an aortopulmonary window (red arrow ? aortopulmonary
window, T ? true lumen, F ? false lumen). An aortopulmonary shunt could not only increase
pulmonary circulation and cause untreatable congestive pulmonary edema but also cause severe
metabolic acidosis. Aortopulmonary artery dissection is a very rare disease but is fatal, requiring
the surgical repair as rapidly as possible.
71-year-old man was brought to the hospital by ambulance and admitted because of
intermittent back pain. Physical examination revealed continuous heart murmur.
Chest X-ray showed cardiomegaly and pulmonary congestion. The patient received
Journal of the American College of Cardiology
© 2009 by the American College of Cardiology Foundation
Published by Elsevier Inc.
Vol. 54, No. 21, 2009