Relevance of width of right descending branch of pulmonary artery as a radiological sign of pulmonary hypertension

Abstract

An enlargement of the diameter of the right descending branch (RDB) of the pulmonary artery in chest radiographs may serve as a sign of pulmonary arterial hypertension. We tried at first to establish exactly the normal values for men and women of different age, analysing the radiographs of 112 healthy subjects. There is a relationship of RDB diameter to sex and age. We compared the RDB diameters in 95 men suffering from chronic bronchitis with the pulmonary arterial pressure, flow, and resistance, and with the right ventricular work: a highly significant relationship of RDB diameter to all but the blood flow values was found. Considering (in men over 40 years of age) a diameter of the RDB of 18 mm. or more as pathological, the reliability of the diagnosis of pulmonary hypertension in chronic bronchitis was 72-2% with readable films, or 64-2% when not reliably readable chest films were included. Nevertheless, a similar comparison in patients with mitral stenosis indicates that the radiographic picture of pulmonary hypertension differs according to the initial disease. Here we discuss the factors which may influence the RDB diameter.Compensated chronic cor pulmonale in chronic bronchitis and its complications frequently escape diagnosis unless an elevated pulmonary artery pressure is found by right heart catheterization.Physical signs of hypertrophy of the right ventricle are rare in the initial stages of cor pulmonale in chronic bronchitis associated with hypoventilation, and electrocardiographic signs are rarely found at this time.Radiological signs of pulmonary hypertension are more useful, as was proved by numerous authors who studied the radiological symptomatology of pulmonary hypertension (Assmann, 1920;Carmichael, Julian, Jones, and Wren, 1954; Dejdar, Widimsky, Valach, Fejfar, and Bergmann, 1959; Van Epps, 1958;Goodwin, Cleland, Hunter, Davies, and Steiner, 1955;Healey, Dow, Sosman, and Dexter, 1949;Milne, 1963;Schwedel, 1946;Steiner, 1957; Teichmann, Drib, Daum, and Ourednfk, 1961). The signs which may be related to pulmonary hypertension are enlargement of the right ventricle, enlargement of the main trunk of the pulmonary artery, enlargement of the hilar branches of the pulmonary artery, in particular of the right descending branch (described also as truncus intermedius or arteria intermedia), narrowing of branches of the peripheral arterial bed, and pulsation of the hilar arteries. We think that some of these signs are not frequent in pulmonary hypertension, or depend too much on the subjective evaluation of the physician, or appear only in heart failure (Teichmann and Drab, 1963).There is general agreement that the most useful radiographic sign is the width of the shadow of the descending branch of the right pulmonary artery (RDB).To elucidate the diagnostic importance of the RBD, we investigated the relation between its diameter and any pulmonary hypertension. We compared catheterization data with the width of the RDB and we tried to find out the difference, if any, between the radiographic appe...

Influence of Aging on Pulmonary Arterial Dynamics and Pulmonary Flow Signal Assessed by Transesophageal Echocardiography

“…The diameter of the right descending branch of the pul monary artery in chest radiographs had a highly signifi cant relation with age as reported by Teichmann et al [10]. Factors influencing the diameter of pulmonary arter ies were body constitution, physical properties of the lung, intrathoracic pressure, elasticity and distensibility of the pulmonary arterial wall, blood volume in the pulmonary arterial bed, pulmonary blood flow and pressure [10].…”

“…ap < 0.05, bp < 0.02, cp < 0.01 vs. 5th decade; dp < 0.05, ep < 0.02 vs. 6th decade, fp < 0.05 vs. 7th decade. The structure and physical properties of the pulmo nary arterial wall have been previously investigated [1][2][3][4][5], and the influence of aging on the pulmonary arterial dimension has been examined using angiography [6][7][8][9], chest radiography [10] and echocardiography [11][12][13].…”

“…Factors influencing the diameter of pulmonary arter ies were body constitution, physical properties of the lung, intrathoracic pressure, elasticity and distensibility of the pulmonary arterial wall, blood volume in the pulmonary arterial bed, pulmonary blood flow and pressure [10].…”

“…They may be related also to age and to the duration of suffering from pulmonary hypertension. The influence of aging on the right pulmonary arterial dimension has been exam ined using angiocardiography [6][7][8][9], chest radiography [10] and suprasternal echocardiography [11][12][13], how ever, little has been reported concerning the influence of This work was supported in part by research Grants-in-Aid for Scientific Research (No. 03807056) from the Japanese Ministry of Education, Science and Culture.…”

Width Measurements of the Shadow of Right Pulmonary Artery Descending Branch on Medium Size Photofluorograms

“…This method is simple, not particularly time-consum-ing, and provides objective measurement data. In previously published studies the width of the shadow of the RDB was measured on radi ograms or tomograms of the lungs [Assmann, 1920;Healey et al, 1949;Dejdar et al, 1959;T eichmann et al, 1970b], or on photofluorograms size 10X10 cm enlarged on the Heliocontrastor to size 35X35 cm [Boudîk et al, 1970;Teichmann et al, 1970a].…”