case_images: PMC6759949_01
case_images: (a) A 59-year-old female with a history of non-ischemic dilated cardiomyopathy and symptoms of dyspnea diagnosed with pulmonary embolus on computed tomography angiography (CTA) 2 years prior. CTA coronal oblique reconstruction demonstrates an isolated linear defect in the right lower lobe pulmonary artery (white arrow). (b) Computed tomography (CT) angiogram demonstrates a hypertrophied arterial structure in the right lung base consistent with a vascular abnormality (white arrow). (c) CT angiogram demonstrates serpiginous hypertrophied arteries in the upper abdomen between the diaphragm and liver (white arrow). (d) AP digital subtraction right renal arteriogram demonstrates a hypertrophied right inferior phrenic artery (white arrow) originating from the right renal artery (black arrow). (e) Selective right inferior phrenic arteriogram demonstrates opacification of the inferior RLL pulmonary artery (white arrow).
case_images: JCIS-9-41-g001.jpg
case_images: PMC6759949_01_JCIS-9-41-g001.jpg
case_images: F1
case_images: A small filling defect diagnosed as PE was reported within the RLL pulmonary artery on CTA imaging 2 years before presentation at our institution [Figure 1a]. CTA at our facility was less convincing in demonstrating RLL pulmonary artery filling defect; however, hypertrophied arteries in the right lung base [Figure 1b] and upper abdomen [Figure 1c] were identified. The right renal angiography confirmed a hypertrophied right inferior phrenic artery [Figure 1d]. Selective arteriogram of the right inferior phrenic artery confirmed flow to the inferior RLL pulmonary artery [Figure 1e].