Pulmonary Artery Vasoconstriction Due to Bronchial Obstruction

Pulmonary artery (PA) vasoconstriction resulting from pulmonary ventilation/perfusion imbalance is infrequently detected with computed tomography (CT). An 85-year-old woman presented to the emergency room with dyspnea and desaturation, despite oxygen supply. A CT pulmonary angiography (CTPA) revealed massive central bronchial mucoid impaction in all but the right upper bronchus. Only the right upper pulmonary veins were opacified, which we speculate was linked to the central bronchial obstruction, with identical distributions, through vasoconstriction of the corresponding PAs. Teaching Point: This case demonstrates the unusual imagery-physiology correlation of pulmonary artery vasoconstriction that cannot normally be detected by CTPA.