Computed tomography appearances of the lung parenchyma in pulmonary hypertension

Abstract

Computed tomography (CT) is a valuable tool in the workup of patients under investigation for pulmonary hypertension (PH) and may be the first test to suggest the diagnosis. CT parenchymal lung changes can help to differentiate the aetiology of PH. CT can demonstrate interstitial lung disease, emphysema associated with chronic obstructive pulmonary disease, features of left heart failure (including interstitial oedema), and changes secondary to miscellaneous conditions such as sarcoidosis. CT also demonstrates parenchymal changes secondary to chronic thromboembolic disease and venous diseases such as pulmonary venous occlusive disease (PVOD) and pulmonary capillary haemangiomatosis (PCH). It is important for the radiologist to be aware of the various manifestations of PH in the lung, to help facilitate an accurate and timely diagnosis. This pictorial review illustrates the parenchymal lung changes that can be seen in the various conditions causing PH.

An Overview of Different Techniques for Improving the Treatment of Pulmonary Hypertension Secondary in Systemic Sclerosis Patients

“…Right heart catheterization (RHC) is the best technique for PAH diagnosis [10][11][12][13][14][15]. The RHC provides useful information on the degree of hemodynamic damage, determines response to treatments and establishes prognosis of PAH [19,[33][34][35][36][37][38][39][40][41][42][43]. The RCH evaluation is recommended when patients have an intermediate or high risk of developing PH, based on ETT evaluation, defined as a TRV peak >2.8 ms −1 , or a TRV <2.8 ms −1 (or not measurable) with other variables suggestive of PH [38].…”

“…The pulmonary vascular involvement in SSc can cause PAH. Typical radiological findings are represented by a main pulmonary artery with a diameter equal of greater than 29 mm measured in a scanning plane of its bifurcation, this sign has a positive predictive value of 97%, sensitivity of 87% and specificity of 89% for the presence of PH [37,40,41].…”

“…The natriuretic peptide (NT-proBNP) is the most frequent used biomarker in SSc, but it is not specific for right ventricular dysfunctions [19,[33][34][35][36][37][38][39][40][41][42][43]. This biomarker may be useful in combination with other screening techniques and in screening algorithms [19,[33][34][35][36][37][38][39][40][41][42][43]. The increase of serum levels of uric acid has been included in the DETECT algorithm [19,[33][34][35][36][37][38][39][40][41][42][43].…”

“…This biomarker may be useful in combination with other screening techniques and in screening algorithms [19,[33][34][35][36][37][38][39][40][41][42][43]. The increase of serum levels of uric acid has been included in the DETECT algorithm [19,[33][34][35][36][37][38][39][40][41][42][43]. Further studies are still needed to demonstrate the utility of blood markers in PAH diagnosis.…”

Predictive value of chest HRCT for survival in idiopathic pulmonary arterial hypertension

“…In IPAH, lung scans are expected to display no significant abnormalities that would suggest underling respiratory disease [ 1 ]. On the other hand, it is now well recognised that up to 50% of PAH patients may present GGO on HRCT scans despite not having any airway or lung parenchymal disease [ 1 , 3 , 6 , 10 – 17 ]. CGGO were seen in 23–28% of patients with I/H/anorexigen-induced PAH, with no signs of PVOD/PCH on lung pathologic evaluation [ 3 , 6 , 15 ].…”