Congenital Absence versus Acquired Attenuation of One Pulmonary Artery

Abstract

The purpose of this study was to determine means, if any, by which the congenital absence of one pulmonary artery could be distinguished from the physiological and radiological attenuation secondary to chronic unilateral lung disease. It was found early in the study that the lung in agenesis of the pulmonary artery remains more or less normal. Therefore, the bedside and fluoro-scope demonstration of good ventilation on the affected side would differ sharply from the diminished ventilation and rales in cases of unilateral lung disease. Mediastinal swing on fluoroscopy would indicate a greatly diminished ventilation on the side into which the heart moves and incriminates severe lung disease. Cardiac catheterization, angiocardiography and aortography have all been found necessary in difficult cases. These disciplines will demonstrate patency of the pulmonary artery in lung disease and opacification of small narrow branches and 1 or 2 bronchial arteries to the disease lung. However, they will depict complete failure of the catheter to enter the pulmonary artery, no opacification of the branches of the PA and massive systemic collaterals in cases of congenital absence of one pulmonary artery. Notching of the ribs, when present, would indicate markedly well developed intercostal collaterals and would be a strong point in favor or pulmonary artery agenesis.