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Subvalvular pulmonary stenosis

Case contributed by Gaurav Som Prakash Gupta
Diagnosis almost certain

Presentation

Atypical chest pain

Patient Data

Age: 30 years
Gender: Male
x-ray

Nodular shadow in the left hilum likely to be vascular - ?dilated main pulmonary artery and left pulmonary artery. Peripheral pruning of the pulmonary vessels. Cardiac size is mildly increased.

The left PA is dilated, while the right PA is normal in caliber. There is no mosaic perfusion- which is contesting against airway cause or pulmonary arterial hypertension as the cause of the dilatation of the pulmonary artery. The ratio of the segmental PA and adjacent bronchi is <1, which is also contesting against precapillary pulmonary hypertension.

(images not shown here) The RV is showing wall thickening (thickness of the free wall of the TV is > 4mm). However, there is no leftward bowing of the IV septum. There is evidence of only very minimal regurgitation of the contrast into the IVC (images not included). The pulmonary veins are normal in caliber, which is contesting against pulmonary venous hypertension.

Case Discussion

A routine chest x-ray picked up the first clues. Clinical correlation and further evaluation by CT scan/echocardiography were suggested. The CT images nicely show subvalvular stenosis with post stenotic dilatation of the pulmonary trunk. 

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