Chronic calcified pulmonary artery thrombosis: A rare cause of dyspnea in a young adult

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Chronic calcified pulmonary artery thrombosis secondary to unrepaired atrioventricular septal defect and pulmonary hypertension (n=1). Intervention: Conservative medical therapy with warfarin and sildenafil. Primary outcome: Clinical stability, thrombus progression, and echocardiographic hemodynamics at 5 years.

Q: What does this research mean for the field?

Conservative medical management with anticoagulation and pulmonary vasodilators can maintain long-term clinical stability without requiring surgical intervention in selected patients with chronic calcified pulmonary artery thrombosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Xiaochun Wang; Binglin Lai

doi:10.33963/v.phj.115735

November 12, 2026Kardiologia PolskaOpen Access

Chronic calcified pulmonary artery thrombosis: A rare cause of dyspnea in a young adult

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Why the study?

Chronic thromboembolism is a recognized complication of congenital heart disease and pulmonary hypertension, such as unrepaired AVSD, but calcified intraluminal thrombi within the central pulmonary arteries are exceedingly rare.

Does conservative medical management with warfarin and sildenafil maintain clinical and morphological stability in a young adult with chronic calcified pulmonary artery thrombosis secondary to unrepaired AVSD and pulmonary hypertension?

Key Points

To describe the clinical presentation, diagnosis, and long-term outcome of conservative medical management for a rare chronic calcified central pulmonary artery thrombus in a young adult with unrepaired atrioventricular septal defect.
Clinical case evaluation of a 20-year-old man presenting with exertional chest tightness, dyspnea, and unrepaired atrioventricular septal defect (N=1).
Diagnostic assessment utilized pulmonary computed tomography angiography with 3D volume rendering, chest X-ray, and transthoracic echocardiography.
Conservative medical strategy was initiated with warfarin (target international normalized ratio 2.0–3.0) and sildenafil, followed prospectively for 5 years without surgical or catheter thrombectomy.
Computed tomography angiography identified a filling defect with intraluminal calcification occluding the right main pulmonary artery and reducing peripheral branching vessels.
At 5-year follow-up on medical therapy, the patient remained clinically asymptomatic with good exercise tolerance, stable thrombus morphology, and no new embolic events.
Follow-up echocardiography revealed an estimated pulmonary artery systolic pressure of 75 mm Hg, right ventricular internal dimension of 31 mm, right ventricular wall thickness of 8 mm, and tricuspid annular systolic velocity of 5 cm/s, demonstrating persistent pulmonary hypertension.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does conservative medical management with warfarin and sildenafil maintain clinical and morphological stability in a young adult with chronic calcified pulmonary artery thrombosis secondary to unrepaired AVSD and pulmonary hypertension?

P

Population

1 young adult man (age 20) with chronic calcified right main pulmonary artery thrombosis secondary to unrepaired atrioventricular septal defect and pulmonary hypertension, followed for 5 years.

I

Intervention

Conservative medical management consisting of anticoagulation with warfarin (target INR 2.0–3.0) and pulmonary vasodilator therapy with sildenafil over 5 years, without surgical or catheter-based interventional thrombectomy.

O

Outcome

Clinical stability (symptom resolution, exercise tolerance) and thrombus stability on repeat imaging at 5-year follow-up.

Limitations

Single patient case report
Conservative management was stabilizing rather than curative, with persistent severe pulmonary hypertension (PASP 75 mm Hg) and reduced right ventricular systolic function (s' 5 cm/s) at 5 years
Conservative management was stabilizing rather than curative, as evidenced by persistent severe pulmonary hypertension and reduced right ventricular systolic function at 5-year follow-up.

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Implication

This case demonstrates that conservative medical management with warfarin and sildenafil can achieve 5-year clinical and morphological stability in selected hemodynamically stable patients with central chronic calcified pulmonary artery thrombosis secondary to congenital heart disease, avoiding mandatory surgery.

Abstract

Chronic thromboembolism is a well-recognized complication in patients with congenital heart disease and pulmonary hypertension.In patients with unrepaired atrioventricular septal defect (AVSD), chronic left-to-right shunting leads to pulmonary vascular remodeling and pulmonary hypertension, which promote endothelial injury, in situ thrombosis, and subsequent organization and calcification of central pulmonary thrombi.However, calcified intraluminal thrombi within the central pulmonary arteries are exceedingly rare.Herein, we report the case of a 20-year-old man with a calcified thrombus in the right main pulmonary artery.The patient was clinically stable for 5 years under conservative management, underscoring that surgery is not always mandatory for such stable lesions.A 20-year-old man with unrepaired AVSD was referred for evaluation of progressively worsening exertional chest tightness and dyspnea over the preceding year.He had no history of syncope, hemoptysis, lower extremity edema, recent immobilization, or surgery.On admission,

Discussion

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Cite This Study

Wang et al. (2026) conducted a case report in Chronic calcified pulmonary artery thrombosis secondary to unrepaired atrioventricular septal defect and pulmonary hypertension (n=1). Conservative medical therapy with warfarin and sildenafil was evaluated on Clinical stability, thrombus progression, and echocardiographic hemodynamics at 5 years.

synapsesocial.com/papers/6af88c410e4d8f4b089c1aa7 https://doi.org/10.33963/v.phj.115735

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Chronic calcified pulmonary artery thrombosis: A rare cause of dyspnea in a young adult

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Chronic calcified pulmonary artery thrombosis: A rare cause of dyspnea in a young adult

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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