Gigantic Pulmonary Arteries

A 49-year-old woman presented with a 12-month history of progressive exertional dyspnea and hoarseness. She had received a diagnosis of primary pulmonary hypertension after an uneventful pregnancy and delivery 22 years earlier. At that time, right heart catheterization showed a mean pulmonary-artery pressure of 42 mm Hg. She was treated with oral anticoagulants, and her condition remained stable thereafter. At the time of her current presentation, an x-ray film of the chest (Panel A) showed gigantic pulmonary arteries and cardiomegaly. Magnetic resonance imaging (Panel B) confirmed the presence of marked dilatation of the main pulmonary artery (long arrows), with peripheral . . .