Pulmonary Artery Rupture as a Complication of Pulmonary Hypertension: Report of a Case and Review of the Literature

A 57-year-old woman with severe thromboembolic pulmonary hypertension died suddenly, approximately 3 hours after pulmonary angiography. Autopsy revealed a hemopericardium (350 mL) due to rupture of the pulmonary artery. Three acute partial intimal-medial tears also were observed. Fatal rupture of the mediastinal pulmonary arteries is a rare complication of severe pulmonary hypertension. A review of eight similar cases indicates that rupture tends to occur in patients with systemic levels of pressure, thrombotic (rather than plexogenic) forms of pulmonary hypertension, and survival longer than two years (mean, 4.5 years) from diagnosis.