Beruflich Dokumente
Kultur Dokumente
PULMONARY
HYPERTENSION
Dr. dr. Rusli Muljadi, Sp. Rad (K)
OUTLINE
1. Introduction
2. Radiology Modalities
3. Classification
4. Imaging workup
5. Approach CT
1. INTRODUCTION
Pulmonary hypertension
Pulmonary hypertension is hemodynamically defined as
a mean pulmonary artery pressure >25 mm Hg at rest
or >30 mm Hg during exercise
• Medical history
• Complications
2. RADIOLOGY MODALITIES
(Diagnosis)
2.1. Chest radiography,
• The central pulmonary arteries are classically enlarged with
rapid tapering of peripheral pulmonary vasculature (pruning)
• Chest radiography may help assess the presence of PH, but the
degree of PH does not correlate with the extent of imaging
abnormalities
Radiographic
Classification
Apical four-chamber
parasternal short-axis views
Impaired Right Ventricular Function
Tricuspid Regurgitation Dilated Inferior Vena Cava
2.3. Ventilation-perfusion (V/Q)
scintigraphy
• To identify or exclude Chronic Thromboembolic PH (CTEPH) in
patients with suspected CTEPH
• Diameter of which frequently exceeds that of the ascending aorta (greater than or
equal to 1)
• Dilatation of the right and left main pulmonary arteries (left PA: >28 mm Right PA:
>24.3 mm)
• Pleural effusion
• Airspace opacities.
• CT is more available than other modalities
IV Chronic
Thromboembolic
Pulmonary Hypertension
V Pulmonary Hypertension related • 5.1 Hematologic disorders
to multifactorial mechanisms • 5.2 Systemic Disorders: Sarcoidosis, Pulmonary histiocytosis, Lymphangioleiomyomatosis
• 5.3 Metabolicdisorders: Glycogen storage disorders, Gaucher disease
• 5.4 Other: Fibrosing Mediastinits, Tumoral calcinosis, Renalfailure
• Related to different
underlying
systemic disease
• Causal relationship
either
multifactorial
and/or not well
understood
Mediastinal Fibrosis: Coronal oblique CT reconstructions
reveal constriction of the pulmonary venous drainage into
the left atrium, causing post capillary pulmonary
hypertension with septal lines (black arrows). Precapillary
hypertension is also evident with MPA dilatation.
Compression to Bronchus
4. IMAGING WORK UP
Peña Elena, et al. RadioGraphics 2012; 32:9–32
• Every patient with suspected PH should undergo Chest
Radiograph and Echocardiography, with the goals of
excluding the most common causes of PH => LV failure and
diffuse lung diseases (COPD and ILD).
• If there is RV failure
- Pulmonary artery
- Pulmonary parenchymal
- Cardiac
- Mediastinal findings.
WHO Classification ‐‐ RadiologicalFlowsheet
Enlarged MPA
Variable
No other Pulmonary Involvement/
abnormalities Heart Lungs Vasculature Systemic
Disease
• Mosaic attenuation : Group 4: CTEPH, Group 1, Group 2, and less frequently group 3
Hyperthropic
Cardiomyopathy
Valve Calcification
• Group 4: CTEPH