Chronic thromboembolic pulmonary hypertension (CTEPH) is a relatively rare but serious sequela of acute pulmonary thromboembolism (PE). Incomplete resolution of pulmonary emboli and secondary pulmonary small vessel arteriopathy are the main causes of vascular occlusion leading to CTEPH [1-4].Depending on the extent of obstructed pulmonary arteries, patients develop various degrees of pulmonary hypertension (PH) and right ventricular failure [4].If left untreated patients show a poor prognosis. [2, 5, 6].CTEPH can be curatively treated by pulmonary endarterectomy (PEA) when lesions are not located distal to the...

Twelve patients (4 women, 8 men with a mean age of 67.5 years) with suspected CTEPH underwent diagnostic workup with retrospectively ECG-gated 256-slice-CT angiography, DSA and RHC. Morphologic image analysis of pulmonary arteries with respect to specific findings of CTEPH was performed by two independent, experienced radiologists. Furthermore interventricular septum (IVS) bowing was measured on reconstructed short axis images of late systole / early diastole (Figure 1). The curvature was quantified by drawing a circle through the interventricular septum and defined as 1 divided by...

In contrast to DSA, the entire pulmonary vasculature was accessible on CT angiograms. CTAshowed a tendency towards higher accuracy of displaying typical vascular changes in central and segmental pulmonary arteries of CTEPH. Moreover, on subsegmental level CT angiography was clearly superior to DSA (202 vs. 160 pathologic vascular segments; P=0.0003) (Table1). Right ventricular hypertrophy was seen in 8 of 12 patients (67 %) and the pulmonary trunk was dilated in 11 of 12 patients (92 %). Parenchymal signs of CTEPH (mosaic perfusion pattern, focal scars)...

CTEPH is a rare disease and misdiagnosis is common because patients often present with nonsepecific or subtle symptoms. High-quality imaging is needed for setting the accurate diagnosis and planning the adequate therapy. DSA is still regarded the diagnostic reference standard. Especially MD-CTA with the currently available generation of CT systems has already reached a level, which equals or even surpasses that of DSA [11, 13]. In our study summarizing all morphological changeson central and segmental lung arteries there was a tendency towards higher accuracy of...

1. Dartevelle, P., et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J, 2004. 23(4): p. 637 -48. 2. Frazier, A.A., et al., From the Archives of AFIP: pulmonary vasculature: hypertension and infarction. Radiographics, 2000. 20(2): p. 491-524; quiz 530-1, 532 3. Piazza, G. and S.Z. Goldhaber, Chronic thromboembolic pulmonary hypertension. N Engl J Med, 2011. 364(4): p. 351-60. 4. Simonneau, G., et al., Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol, 2009. 34 (1 Suppl): p. S43-54 5. Fedullo, P.F., et al., Chronic...