Central Pulmonary Artery Lesions in Chronic Obstructive Pulmonary Disease

Abstract

Background-In patients with acute pulmonary embolism, transesophageal echocardiography (TEE) often reveals presumably thrombotic lesions within the central pulmonary arteries (CPAs). These CPA lesions, when found in patients with primary pulmonary hypertension, have been attributed to in situ thrombosis 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 pulmonary embolism or ileofemoral and popliteal vein thrombosis. By use of TEE, CPA lesions were found in 12 COPD patients (48%) and 2 control patients (7.4%) (PϽ0.01). 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 patients, respectively (PϭNS). Conversely, type 2 lesions, which were always localized in the right pulmonary artery, were frequent in COPD patients (36%) and rare in control patients (3.7%) (PϽ0.01). When available, helical CT and MR angiography confirmed TEE findings, supporting an atherosclerotic origin of type 2 lesions, which were different from typical thrombotic lesions. FEV 1 /FVC ratio, RV/TLC ratio, PaO 2 , hematocrit value, and pulmonary artery systolic pressure were not significantly different in COPD patients with and without CPA lesions. At TEE, however, COPD patients with CPA lesions showed 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 relation with the severity of pulmonary dysfunction.

Clinical presentation and outcome of venous thromboembolism in COPD

“…Elsewhere, links between obesity, adipokines and the abnormal inflammatory response seen in COPD are currently debated [38] and the potential effect of these interactions on pro-thrombotic states in COPD patients deserves further research. Moreover, the pulmonary arteries of COPD patients are characterised by endothelial cell dysfunction [39] and the hypothetical COPDrelated pro-thrombotic status may predominate with regard to the pulmonary vascular bed, leading to in situ thrombosis [40].…”

Case report: Optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography

“…Indeed, in severe PE, the distribution of emboli is most commonly bilateral. 8 Moreover, since the RPA is in greater flow continuity with the pulmonary trunk, 20 emboli are consistently found on the right. Also, in massive PE, secondary signs facilitate diagnosis.…”

Mechanisms of atherothrombosis in chronic obstructive pulmonary disease

“…That a pro-coagulant status may promote atherothrombosis in COPD is suggested by the direct relationship between serum fi brinogen and the incidence of cardiovascular events in the general population (Danesh et al 1998). Interestingly, central pulmonary lesions, indicative of in situ thrombosis and atherosclerosis, are common in stable COPD patients even free from pulmonary hypertension, and their extent is not strictly related to the severity of bronchial obstruction (Russo et al 1999). This fi nding testifi es to a procoagulant and proatherosclerotic status which can be recognized early in the course of COPD.…”