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October 2, 1981

Compression of Pulmonary Artery by Aortic Aneurysm

JAMA. 1981;246(14):1586-1587. doi:10.1001/jama.1981.03320140074037

ANEURYSMS of the ascending aorta may involve the main pulmonary artery or its branches by compression or by rupture and formation of an aortopulmonary artery fistula. While the diagnosis may be suggested from the chest roentgenogram, large midline ascending aortic aneurysms may be present yet not radiologically detectable. Diagnosis often requires pulmonary arteriography with visualization of the levophase as described herein.

Report of a Case  A 67-year-old woman had severe rightsided pleuritic chest pain, dyspnea, and hemoptysis for three days. The patient had been receiving warfarin sodium (Coumadin) for phlebitis but was unreliable in taking her medications. Her history included cancer of the bladder with bone metastasis and rheumatic heart disease.During physical examination, the patient was an anxious, diaphoretic woman in severe respiratory distress with considerable splinting of the right thorax. Her respirations were 24/min and blood pressure was 170/80 mm Hg. Breath sounds at the right base were