Stenotic lesions of pulmonary arteries: imaging evaluation using multidetector computed tomography angiography


      • Stenotic lesions of pulmonary arteries can be congenital or acquired.
      • Clinical scenario, age at presentation and triggering event provide clues to etiology.
      • CT angiography allows intra/extraluminal along with pulmonary arterial wall imaging.
      • Related anomalies, causative lung lesions and effects on heart/lungs can be assessed.


      Stenotic lesions of the pulmonary arteries can be congenital or acquired. Different etiologies may affect the pulmonary arteries, unilaterally or bilaterally, at different levels. The clinical scenario, age of presentation and the precipitating event may provide clues to the underlying etiology. Diagnosis is important as these lesions may have hemodynamic and clinical consequences. Multidetector computed tomography angiography allows for accurate depiction of these lesions along with a comprehensive assessment of the pulmonary arterial wall, intra- or extraluminal involvement, associated cardiac or extracardiac anomalies, effects secondary to pulmonary stenosis on the cardiac chambers as well as associated causative or resultant lung parenchymal changes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Anderson R.H.
        • Webb S.
        • Brown N.A.
        • Lamers W.
        • Moorman A.
        Development of the heart: (3) formation of the ventricular outflow tracts, arterial valves, and intrapericardial arterial trunks.
        Heart (British Cardiac Society). 2003; 89: 1110-1118
        • Mittal S.
        Isolated infundibular pulmonary stenosis.
        Journal of Clinical and Preventive Cardiology. 2018; 7: 154-160
        • Rahman M.M.
        • Sunny M.S.
        • Hasan M.K.
        • Adhikary A.
        Isolated infundibular pulmonary stenosis in adult: a case report.
        Journal of Dhaka Medical College. 2015; 23
        • Shyu K.G.
        • Tseng C.D.
        • Chiu I.S.
        • Hung C.R.
        • Chu S.H.
        • Lue H.C.
        • et al.
        Infundibular pulmonic stenosis with intact ventricular septum: a report of 15 surgically corrected patients.
        Int J Cardiol. 1993; 41: 115-121
      1. Gadgil P, A Khiste J, B Madane R, A Pandit G, C Mahajan K. Sudden Death in a Case of Isolated Infundibular Pulmonary Stenosis (IPS) – a Rare case 2015. 55-6 p.

        • Hayes C.J.
        • Gersony W.M.
        • Driscoll D.J.
        • Keane J.F.
        • Kidd L.
        • O’Fallon W.M.
        • et al.
        Second natural history study of congenital heart defects. Results of treatment of patients with pulmonary valvar stenosis.
        Circulation. 1993; 87: I28-I37
        • Anwar A.M.
        • Soliman O.
        • van den Bosch A.E.
        • JS McGhie
        • Geleijnse M.L.
        • ten Cate F.J.
        • et al.
        Assessment of pulmonary valve and right ventricular outflow tract with real-time three-dimensional echocardiography.
        Int J Cardiovasc Imaging. 2007; 23: 167-175
        • Merrill W.H.
        • Stewart J.R.
        • Hammon Jr., J.W.
        • Boucek Jr., R.J.
        • Bender Jr., H.W.
        Surgical management of patients with pulmonary valve dysplasia.
        Ann Thorac Surg. 1986; 42: 264-268
        • Ling J.
        • Xie R.
        • Xu L.
        Percutaneous balloon pulmonary valvuloplasty and results of mid-long term follow up.
        Zhonghua Xin Xue Guan Bing Za Zhi. 2003; 31: 323-325
        • Liu X.G.
        • Wu K.H.
        • Shi C.
        • Li X.F.
        • Wang Z.Y.
        • Tang Z.
        The clinical results of right ventricular outflow tract reconstruction with a transannular patch of autologous pericardium.
        Zhonghua Yi Xue Za Zhi. 2007; 87: 553-555
        • Sun Z.
        • Xu W.
        • Huang S.
        • Chen Y.
        • Guo X.
        • Shi Z.
        Dual-source computed tomography evaluation of children with congenital pulmonary valve stenosis.
        Iran J Radiol. 2016; 13e34399
        • Saremi F.
        • Gera A.
        • Ho S.Y.
        • Hijazi Z.M.
        • Sanchez-Quintana D.
        CT and MR imaging of the pulmonary valve.
        Radiographics. 2014; 34: 51-71
        • Aziz M.
        • Krishnam M.
        • Madhuranthakam A.J.
        • Rajiah P.
        Update on MR imaging of the pulmonary vasculature.
        Int J Cardiovasc Imaging. 2019; 35: 1483-1497
        • Castaneda-Zuniga W.R.
        • Formanek A.
        • Amplatz K.
        Radiologic diagnosis of different types of pulmonary stenoses.
        Cardiovasc Radiol. 1977; 1: 45-57
        • Bashore T.M.
        Adult congenital heart disease: right ventricular outflow tract lesions.
        Circulation. 2007; 115: 1933-1947
        • Hurwitz L.E.
        • Roberts W.C.
        Quadricuspid semilunar valve.
        Am J Cardiol. 1973; 31: 623-626
      2. Mazur Wa, Siegel MJa, Miszalski-Jamka Ta, Pelberg Ra, Bratko Mi. CT atlas of adult congenital heart disease.

        • Digilio M.
        • Marino B.
        Clinical manifestations of Noonan syndrome.
        Images in paediatric cardiology. 2001; 3: 19-30
        • Coppin B.D.
        • Temple I.K.
        Multiple lentigines syndrome (LEOPARD syndrome or progressive cardiomyopathic lentiginosis).
        J Med Genet. 1997; 34: 582-586
        • Bruno E.
        • Rossi N.
        • Thuer O.
        • Cordoba R.
        • Alday L.E.
        Cardiovascular findings, and clinical course, in patients with Williams syndrome.
        Cardiol Young. 2003; 13: 532-536
        • Bharati A.
        • Naware A.
        • Merchant S.
        Absent pulmonary valve syndrome with tetralogy of Fallot and associated dextrocardia detected at an early gestational age of 26 weeks.
        Indian Journal of Radiology and Imaging. 2008; 18: 352-354
        • Hirsig L.E.
        • Sharma P.G.
        • Verma N.
        • Rajderkar D.A.
        Congenital pulmonary artery anomalies: a review and approach to classification.
        Journal of clinical imaging science. 2018; 8: 29
        • Turner D.
        • Vincent J.
        • Epstein M.
        Isolated right pulmonary artery discontinuity.
        Images in paediatric cardiology. 2000; 2: 24-30
        • Apostolopoulou S.C.
        • Kelekis N.L.
        • Brountzos E.N.
        • Rammos S.
        • Kelekis D.A.
        “Absent” pulmonary artery in one adult and five pediatric patients: imaging, embryology, and therapeutic implications.
        AJR Am J Roentgenol. 2002; 179: 1253-1260
        • Lepeschkin E.
        On the relation between the site of valvular involvement in endocarditis and the blood pressure resting on the valve.
        Am J Med Sci. 1952; 224: 318-319
        • Ramadan F.B.
        • Beanlands D.S.
        • Burwash I.G.
        Isolated pulmonic valve endocarditis in healthy hearts: a case report and review of the literature.
        Can J Cardiol. 2000; 16: 1282-1288
        • Seraj S.M.
        • Gill E.
        • Sekhon S.
        Isolated pulmonary valve endocarditis: truth or myth?.
        J Community Hosp Intern Med Perspect. 2017; 7: 329-331
        • Yuan S.M.
        Valvular disorders in carcinoid heart disease.
        Braz J Cardiovasc Surg. 2016; 31: 400-405
        • Xia H.
        • Jiang Y.
        • Cai Y.
        • Tang J.
        • Gao Y.
        • Sun J.P.
        Isolated pulmonary Vasculitis.
        Circulation. 2015; 132 (e235-e8)
        • Kreutzer J.
        • Landzberg M.J.
        • Preminger T.J.
        • Mandell V.S.
        • Treves S.T.
        • Reid L.M.
        • et al.
        Isolated peripheral pulmonary artery stenoses in the adult.
        Circulation. 1996; 93: 1417-1423
        • Seymour J.
        • Emanuel R.
        • Pattinson N.
        Acquired pulmonary stenosis.
        Br Heart J. 1968; 30: 776-785
        • Littler W.A.
        • Meade J.B.
        • Hamilton D.I.
        Acquired pulmonary stenosis.
        Thorax. 1970; 25: 465-471