CT Scan Findings in Chronic Thromboembolic Pulmonary Hypertension

Utility of computed tomography in assessment of pulmonary hypertension secondary to biomass smoke exposure

“…In thromboembolic pulmonary hypertension and primary pulmonary hypertension, 2 studies found a correlation between mPAD and mean PAP (r=0.43, p<0.01; r=0.42, p<0.001), but no correlation was found in a third study [32–34]. In contrast, we found a significant correlation between sPAP and mPAD in patients with chronic lung diseases, as well as in idiopathic pulmonary arterial hypertension-like group patients and asymptomatic idiopathic pulmonary arterial hypertension-like group patients, who may share similar pathogenesis with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension.…”

Dual-Energy CT Angiography for Assessment of Regional Pulmonary Perfusion in Patients With Chronic Thromboembolic Pulmonary Hypertension: Initial Experience

“…Other factors, such as a heavy distal disease burden (below the spatial resolution of current generation CT scanners) and the development of small vessel (< 100 μm) vasculopathy secondary to shunting of blood into unobstructed lung regions, are thought to play important roles [13].…”

“…A high number of lobes with a mosaic pattern of lung attenuation (characterized by areas of ground-glass attenuation with enlarged vascular segments, intermingled with areas of low attenuation with smaller vascular segments) is an adverse prognostic indicator for pulmonary thromboendarterectomy and is thought to reflect extensive distal disease burden [13,14]. Depiction of dilated bronchial arteries is positively correlated with survival following pulmonary thromboendarterectomy and is thought to indicate relative sparing of distal pulmonary arterioles [15].…”

“…The additional assessment of parenchymal perfusion may therefore hold prognostic relevance, especially in patients with inhomogeneous disease distribution [13]. A variety of noninvasive imaging techniques can be used to assess regional pulmonary perfusion, including ventilation-perfusion (V/Q) scintigraphy and MR angiography (MRA); however, each technique has well-described limitations [16,17].…”

Impact of CT perfusion imaging on the assessment of peripheral chronic pulmonary thromboembolism: clinical experience in 62 patients

“…The best candidates for pulmonary thromboendarterectomy are patients with central thrombi and no peripheral disease [4,15]. Patients with predominantly peripheral, surgically inaccessible disease, and patients with residual peripheral disease following surgery, can develop postoperative pulmonary hypertension, which may be lethal [16][17][18]. Lastly, whereas disease in the segmental vessels is still surgically accessible, it is more difficult and technically demanding [19].…”