Imaging in pulmonary hypertension, part 2: large vessel diseases

Gopalan, Deepa; McCann, Caroline; Sheares, Karen; Screaton, Nicholas

doi:10.1136/postgradmedj-2011-130274

Cited by 16 publications

(11 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients with predominantly proximal vascular distribution may be treated with pulmonary artery endarterectomy, while more distally located CTEPH is not amenable to surgery and must be treated medically (84). Endarterectomy can lead to major health improvement.…”

Section: Ct Findings Of Cteph As a Complication Of Acute Pementioning

confidence: 99%

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

View full text Add to dashboard Cite

A cute pulmonary embolism (PE) is the third most common cardiovascular condition, after coronary artery disease and stroke (1). Due to lack of specific sets of symptoms that accurately predict or exclude the diagnosis of acute PE, the diagnosis strongly relies on noninvasive imaging techniques. Diagnostic strategies for evaluating PE have undergone important changes over the past decades (2). Due to rapid technical advances in speed and spatial resolution, the utility of computed tomography (CT) angiography has been recognized in vascular imaging. Particularly, after the development of multidetector row CT in 1998 (3), CT pulmonary angiography (CTPA) has become the imaging method of choice in the diagnosis of acute PE (4). CTPA has advantages over conventional invasive X-ray pulmonary angiography and nuclear ventilation-perfusion (V/Q) imaging. CT is a widely available, fast and noninvasive technique, has the capability to directly visualize emboli, and may provide alternative diagnoses (4).Despite adequate diagnosis and anticoagulant therapy, death rate after a diagnosis of acute PE is still 8%-15% (5, 6). The prognosis of acute PE mainly depends on residual pulmonary circulation and the severity of right ventricular (RV) dysfunction (7). Recent studies have shown that CT permits the assessment of acute right-sided heart failure. Furthermore, CT can predict adverse clinical outcome by using the RV/left ventricular (LV) diameter ratio (8, 9) or RV ejection fraction in patients with PE (10).The aim of this review is to discuss the developments of CT in PE diagnosis, and to analyze the added value of CT in estimating PE severity and prognosis. Furthermore, CT findings of chronic thromboembolic pulmonary arterial hypertension (CTEPH) as a complication of acute PE will be discussed. CT developments in PE diagnosisHistorically, pulmonary angiography and nuclear planar V/Q-imaging were the main imaging methods used for diagnosing PE. Both methods have recognized limitations. Pulmonary angiography has previously been regarded as reference standard, but the method CHEST IMAGING REVIEW ABSTRACT Pulmonary embolism (PE) is a potentially life threatening condition requiring adequate diagnosis and treatment. Computed tomography pulmonary angiography (CTPA) is excellent for including and excluding PE, therefore CT is the first-choice diagnostic imaging technique in patients suspected of having acute PE. Due to its wide availability and low invasiveness, CTPA tends to be overused. Correct implementation of clinical decision rules in diagnostic workup for PE improves adequate use of CT. Also, CT adds prognostic value by evaluating right ventricular (RV) function. CT-assessed RV dysfunction and to lesser extent central emboli location predicts PE-related mortality in normotensive and hypotensive patients, while PE embolic obstruction index has limited prognostic value. Simple RV/left ventricular (LV) diameter ratio measures >1.0 already predict risk for adverse outcome, whereas ratios <1.0 can safely exclude adverse outcome. Con...

show abstract

Section: Ct Findings Of Cteph As a Complication Of Acute Pementioning

confidence: 99%

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

View full text Add to dashboard Cite

show abstract

“…However, evidence of lung parenchymal fibrosis was not observed on CT of the BAF group in the present study. We speculate that extrinsic compression of pulmonary arteries by adjacent peribronchial fibrosis of larger airways may contribute to more common and severe pulmonary hypertension in patients with BAF like fibrosing mediastinitis 27 . However, this finding was not noted on CT of the BAF group.…”

Section: Discussionmentioning

confidence: 92%

Clinical Relevance of Bronchial Anthracofibrosis in Patients with Chronic Obstructive Pulmonary Disease Exacerbation

et al. 2014

View full text Add to dashboard Cite

BackgroundBronchial anthracofibrosis (BAF), which is associated with exposure to biomass smoke in inefficiently ventilated indoor areas, can take the form of obstructive lung disease. Patients with BAF can mimic or present with an exacerbation of chronic obstructive pulmonary disease (COPD). The purpose of the current study was to investigate the prevalence of BAF in Korean patients with COPD exacerbation as well as to examine the clinical features of these patients in order to determine its clinical relevance.MethodsA total of 206 patients with COPD exacerbation were divided into BAF and non-BAF groups, according to computed tomography findings. We compared both clinical and radiologic variables between the two groups.ResultsPatients with BAF (51 [25%]) were older, with a preponderance of nonsmoking women; moreover, they showed a more frequent association with exposure to wood smoke compared to those without BAF. However, no differences in the severity of illness and clinical course between the two groups were observed. Patients in the BAF group had less severe airflow obstruction, but more common and severe pulmonary hypertension signs than those in the non-BAF group.ConclusionCompared with non-BAF COPD, BAF may be associated with milder airflow limitation and more frequent signs of pulmonary hypertension with a more severe grade in patients presenting with COPD exacerbation.

show abstract

“…11), soft tissue sarcomas, and atrial myxomas, but it has also been reported in multiple other tumor types like breast cancer, gastric cancer, liver cancer, thyroid cancer, testicular cancer, and uterine cancer. 9 In an autopsy study by Winterbauer et al, 71 tumor embolization was found in 26% of patients with cancer and in about 8% of the cases, it was a significant cause of death of the patient. 71 We reported a case of right atrial myxoma metastases to the pulmonary arteries giving the appearance of chronic thromboembolic lesions.…”

Section: Sarcoidosismentioning

confidence: 98%

Mimickers of chronic thromboembolic pulmonary hypertension on imaging tests: a review

Narechania¹,

Renapurkar²,

Heresi³

2020

Pulm. circ.

View full text Add to dashboard Cite

Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by mechanical obstruction of large pulmonary arteries secondary to one or more episodes of pulmonary embolism. Ventilation perfusion scan is the recommended initial screening test for this condition and typically shows multiple large mismatched perfusion defects. However, not all patients with an abnormal ventilation perfusion scan have CTEPH since there are other conditions that be associated with a positive ventilation perfusion scan. These conditions include in situ thrombosis, pulmonary artery sarcoma, fibrosing mediastinitis, pulmonary vasculitis and sarcoidosis, among others. Although these conditions cannot be distinguished from CTEPH using a ventilation perfusion scan, they have certain characteristic radiological features that can be demonstrated on other imaging techniques such as computed tomography scan and can help in differentiation of these conditions. In this review, we have summarized some key clinical and radiological features that can help differentiate CTEPH from the CTEPH mimics.

show abstract

Imaging in pulmonary hypertension, part 2: large vessel diseases

Cited by 16 publications

References 47 publications

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Clinical Relevance of Bronchial Anthracofibrosis in Patients with Chronic Obstructive Pulmonary Disease Exacerbation

Mimickers of chronic thromboembolic pulmonary hypertension on imaging tests: a review

Contact Info

Product

Resources

About