Case report: Multimodality imaging of unusual coronary to pulmonary collaterals in chronic thromboembolic pulmonary hypertension

• DOI: 10.3389/fcvm.2023.1204736
• Publication Date: 2023-06-08T06:13:34Z
• Authors: Ansh Goyal; Ryan Avery; Michael J. Cuttica; James D. Flaherty; S. Chris Malaisrie; Ruben Mylvaganam
• Keywords: coronary angiogram; 03 medical and health sciences; 0302 clinical medicine; collaterals; RC666-701; CTEPH; pulmonary endarterectomy; Diseases of the circulatory (Cardiovascular) system; DECT; Cardiovascular Medicine; pulmonary angiography

We present unusual coronary-pulmonary collaterals in a 65-year-old CTEPH patient. Perfusion mapping of a dual-energy computed tomography (DECT) study revealed areas of right lung that were minimally perfused despite unilateral occlusion of the right pulmonary artery, leading to the discovery of coronary-pulmonary collaterals via invasive coronary angiography. Pulmonary thromboendarterectomy removed the clot en-bloc. Post-surgery DECT and catheterization confirmed restoration of pulmonary arterial circulation and excellent hemodynamic response. Here, suggestion of perfusion to a proximally obstructed lung with DECT helped to document the presence of rarely documented coronary-pulmonary artery collaterals.