Pulmonary Hypertension: CT of the Chest in Pulmonary Venoocclusive Disease

Abstract

On the initial pretreatment chest CT scan, the presence of ground-glass opacities (particularly with a centrilobular distribution), septal lines, and adenopathy are indicative of pulmonary venoocclusive disease in patients displaying pulmonary hypertension. Caution should be exercised before vasodilator therapy is initiated in the patients whose scans show such radiologic abnormalities.

Guidelines for the diagnosis and treatment of pulmonary hypertension

“…High-resolution CT scanning is the investigation of choice. Typical findings suggestive of PVOD are the presence of subpleural thickened septal lines, centrilobular ground-glass opacities (contrasting with a panlobular distribution found in IPAH) and mediastinal lymphadenopathy [54]. The association of these three findings was found to be 100% specific for PVOD in cases of PAH, with a 66% sensitivity [54].…”

Pulmonary veno-occlusive disease: advances in clinical management and treatments

“…Respiratory auscultatory crackles may occur in PVOD patients with predominant pulmonary infiltrates but the precise prevalence is unknown [7,10]. Pleural effusions have been suggested to be more frequent in PVOD, however, the studies focused on radiography with high-resolution computed tomography (HRCT) of the chest show a similar proportion of pleural effusions in both diseases [8,10,48,49]. Hemoptysis has been described in PVOD; however, in our recent study, hemoptysis was reported infrequently and equally in both idiopathic PAH and PVOD, confirming that alveolar hemorrhage in PVOD is generally occult [8,50].…”

“…In contrast, the chest radiograph in PVOD may show significant abnormalities with Kerley B lines or signs of pulmonary edema, most frequently occurring after initiation of pulmonary vasodilator therapy [6,8,10,48,67]. HRCT of the chest may also help to discriminate PVOD and PAH in less acute situations [8,10,48,49] (Figure 3). It has been clearly demonstrated that HRCT in PVOD was characterized by a higher frequency of centrilobular ground-glass opacities, septal lines and mediastinal lymph node enlargement Review as compared with idiopathic PAH [49].…”

“…HRCT of the chest may also help to discriminate PVOD and PAH in less acute situations [8,10,48,49] (Figure 3). It has been clearly demonstrated that HRCT in PVOD was characterized by a higher frequency of centrilobular ground-glass opacities, septal lines and mediastinal lymph node enlargement Review as compared with idiopathic PAH [49]. Pleural effusion and other abnormal parenchymal findings were not significantly associated with PVOD [49].…”

“…It has been clearly demonstrated that HRCT in PVOD was characterized by a higher frequency of centrilobular ground-glass opacities, septal lines and mediastinal lymph node enlargement Review as compared with idiopathic PAH [49]. Pleural effusion and other abnormal parenchymal findings were not significantly associated with PVOD [49]. We have reported that the presence of two or three radiological abnormalities (including lymph node enlargement, septal lines and centrilobuar ground-glass opacities) were present in 75% of HRCT from patients displaying histologically proven PVOD [8].…”