{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T09:37:27Z","timestamp":1786700247122,"version":"build-2736575974"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Spontaneous pulmonary artery (PA) dissection is an extremely rare and life-threatening complication of chronic pulmonary hypertension, most commonly associated with congenital heart disease. We report a 54-year-old woman who presented with sharp chest pain, progressive dyspnea, and differential cyanosis between the upper and lower extremities. Laboratory evaluation revealed secondary erythrocytosis and elevated NT-proBNP. Transthoracic echocardiography demonstrated a markedly dilated pulmonary trunk, severe pulmonary hypertension, and a large patent ductus arteriosus with bidirectional shunting. Contrast-enhanced computed tomography confirmed spontaneous PA dissection involving the main pulmonary trunk and both pulmonary arteries. Because of established Eisenmenger physiology, surgical repair was not feasible; the patient declined further intervention and was managed conservatively with diuretics, pulmonary vasodilators, and carefully monitored anticoagulation. She was subsequently discharged against medical advice and lost to follow-up. This case highlights differential cyanosis as a bedside marker of right-to-left ductal shunting, summarizes previously reported cases and their outcomes, and discusses the management challenges of this rare condition.<\/jats:p>","DOI":"10.3389\/fcvm.2026.1853793","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T09:10:21Z","timestamp":1786698621000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary artery dissection with patent ductus arteriosus presenting with differential cyanosis: a case report and review of literature"],"prefix":"10.3389","volume":"13","author":[{"given":"YeFu","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Chengdu Shang Jin Nan Fu Hospital, West China Hospital of Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dou","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Chengdu Shang Jin Nan Fu Hospital, West China Hospital of Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1136\/hrt.2004.045799","article-title":"Pulmonary artery dissection: an emerging cardiovascular complication in surviving patients with chronic pulmonary hypertension","volume":"91","author":"Khattar","year":"2005","journal-title":"Heart"},{"key":"B2","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/j.ijscr.2013.02.011","article-title":"A rare complication of pre-Eisenmenger patent ductus arteriosus: pulmonary artery dissection","volume":"4","author":"Ay","year":"2013","journal-title":"Int J Surg Case Rep"},{"key":"B3","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1111\/jocs.12529","article-title":"Pulmonary artery dissection","volume":"30","author":"Perrotta","year":"2015","journal-title":"J Card Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1161\/CIRCULATIONAHA.114.012907","article-title":"Aneurysms of the pulmonary artery","volume":"131","author":"Kreibich","year":"2015","journal-title":"Circulation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.hrtlng.2015.06.006","article-title":"Pulmonary artery dissection in a patient with undiagnosed pulmonary hypertension\u2014a case report and review of literature","volume":"44","author":"Malm","year":"2015","journal-title":"Heart Lung"},{"key":"B6","doi-asserted-by":"publisher","first-page":"195","DOI":"10.3904\/kjim.2016.258","article-title":"Pulmonary artery dissection in a patient with Eisenmenger's syndrome and successful conservative medical treatment","volume":"32","author":"Hong","year":"2017","journal-title":"Korean J Intern Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.euje.2003.09.003","article-title":"Pulmonary artery dissection in a patient with Eisenmenger syndrome treated with heart and lung transplantation","volume":"5","author":"T\u00f8nder","year":"2004","journal-title":"Eur J Echocardiogr"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1161\/CIRCULATIONAHA.105.592063","article-title":"Patent ductus arteriosus","volume":"114","author":"Schneider","year":"2006","journal-title":"Circulation"},{"key":"B9","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1016\/j.hrtlng.2019.02.007","article-title":"Pulmonary artery dissection\u2014a review of 150 cases","volume":"48","author":"Fernando","year":"2019","journal-title":"Heart Lung"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2110","DOI":"10.1056\/NEJMc063492","article-title":"Pulmonary-artery dissection in patients with Eisenmenger\u2019s syndrome","volume":"356","author":"Westaby","year":"2007","journal-title":"N Engl J Med"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1853793\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T09:10:21Z","timestamp":1786698621000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1853793\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":10,"alternative-id":["10.3389\/fcvm.2026.1853793"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1853793","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]},"article-number":"1853793"}}