EURORAD ESR

Case 8571

The late sequalae of pulmonary hypertension

Author(s)
Cortis K, Micallef K, Mizzi A.
Medical Imaging Department, Mater Dei Hospital, Malta.
 
Patient
female, 52 year(s)
 
 
  • Figure 1
    Plain radiography
     

    Plain frontal chest radiograph demonstrates enlarged central pulmonary arteries, pruning of the peripheral branches, and a well-defined distinct `pulmonary nodule´ in the midzone of the right lung.

     

    Lateral views confirm the enlarged central pulmonary arteries. Apposition of more than one third of the anterior heart border to the sternum is evident. This strongly suggests enlargement of the right ventricle.

     

    Lateral views confirm the enlarged central pulmonary arteries. Apposition of more than one third of the anterior heart border to the sternum is evident. This strongly suggests enlargement of the right ventricle.

     
     
     
  • Figure 2
    Axial contrast enhanced CT through the thorax

    Axial CT shows grossly dilated pulmonary arteries. The pulmonary trunk was dilated with a diameter of up to 6.2cm. Arterialisation of the main pulmonary arteries was also noted, with peripheral mural calcification....

     
     
     
  • Figure 3
    Multi-planar CT reconstructions in the coronal plane
     

    Coronal reconstructions of the axial contrast enhanced CT shown in Figure 2, with proper windowing in order to enhance the appearance of the pulmonary arterial tree.

     

    Coronal reconstructions of the axial contrast enhanced CT shown in Figure 2, with proper windowing in order to enhance the appearance of the pulmonary arterial tree.

     

    Coronal reconstructions of the axial contrast enhanced CT shown in Figure 2, with proper windowing in order to enhance the appearance of the pulmonary arterial tree.

     

    Coronal reconstructions of the axial contrast enhanced CT shown in Figure 2, with proper windowing in order to enhance the appearance of the pulmonary arterial tree.

     
     
     
  • Figure 4
    The Venice 2003 Revised WHO Classification of Pulmonary Hypertension

    The Venice 2003 Revised WHO Classification of Pulmonary Hypertension

     
     
     
Plain frontal chest radiograph demonstrates enlarged central pulmonary arteries, pruning of the peripheral branches, and a well-defined distinct `pulmonary nodule´ in the midzone of the right lung.
 
Lateral views confirm the enlarged central pulmonary arteries. Apposition of more than one third of the anterior heart border to the sternum is evident. This strongly suggests enlargement of the right ventricle.
 
Lateral views confirm the enlarged central pulmonary arteries. Apposition of more than one third of the anterior heart border to the sternum is evident. This strongly suggests enlargement of the right ventricle.
 
Axial CT shows grossly dilated pulmonary arteries. The pulmonary trunk was dilated with a diameter of up to 6.2cm. Arterialisation of the main pulmonary arteries was also noted, with peripheral mural calcification. Peripheral chronic thrombus can be seen lining the left lower lobe pulmonary artery and its branches. Gross dilatation of the right ventricular and right atrium is also evident, together with prominent trabeculation of the ventricular wall. All these features are consistent with chronic pulmonary arterial hypertension. A lobulated hypodense lesion was seen within the right lower lobe of lung. This measures 4 cm in cranio-caudal diameter, 2.1 cm in transverse diameter and 2.1 cm in antero-posterior diameter. The lesion has very well delineated margins and appears hypodense, most probably representing an incidental hamartoma.
 
Coronal reconstructions of the axial contrast enhanced CT shown in Figure 2, with proper windowing in order to enhance the appearance of the pulmonary arterial tree.
 
Coronal reconstructions of the axial contrast enhanced CT shown in Figure 2, with proper windowing in order to enhance the appearance of the pulmonary arterial tree.
 
Coronal reconstructions of the axial contrast enhanced CT shown in Figure 2, with proper windowing in order to enhance the appearance of the pulmonary arterial tree.
 
Coronal reconstructions of the axial contrast enhanced CT shown in Figure 2, with proper windowing in order to enhance the appearance of the pulmonary arterial tree.
 
The Venice 2003 Revised WHO Classification of Pulmonary Hypertension
 
 
 
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