Multimodality approach to pulmonary hypertension: the Radiologist's role

Congress:

ECR 2019

Poster Number:

C-2279

Type:

Educational Exhibit

Keywords:

Embolism / Thrombosis, Education and training, Education, Diagnostic procedure, MR, CT-Angiography, CT, Pulmonary vessels, Lung, Cardiovascular system

Authors:

J. Carvalho¹, J. Amorim¹, A. M. Alves¹, J. S. F. Pinto², C. Fernandes¹, M. França³; ¹Porto/PT, ²Porto, PT/PT, ³Maia/PT

DOI:

10.26044/ecr2019/C-2279

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2279

Fig. 1: Suggested work-up of pulmonary hypertension (adapted from the 2015 ESC/ERS...

Fig. 2: 82 year old patient with heart enlargement, prominent main pulmonary artery...

Fig. 3: 75 year old patient with CTEPH. A, B, C. CTPA with MPA dilation and eccentric...

Fig. 4: 72 year old patient with group 4 PH with eccentric filling defects in the left...

Learning objectives

Review the classification and different imaging findings of pulmonary hypertension (PH). Discuss how the radiologist can make a difference in the clinical management of these patients.

Background

PH is defined as an increase in mean pulmonary arterial pressure ≥25mmHg at rest assessed by right heart catheterization (RHC). The latest World Health Organization, revised in Nice, France, in 2013, divides PH in five different groups, according to their clinical presentation, pathologic findings and treatment strategies: Group 1: Pulmonary artery hypertension (PAH) Group 2: PH due do left heart disease Group 3: PH due to lung diseases and/or hypoxia Group 4: Chronic thromboembolic PH (CTEPH) Group 5: PH with unclear and/or multifactorial mechanisms. The...

Findings and procedure details

Chest radiograph isabnormal in 90% of casesat the time of diagnosis[1]. In addition, it may be helpful in diagnosing lung disease and pulmonary venous congestion due to left heart disease (group 3 and 2, respectively). Basic imaging signs are the same for all types of PH. However, radiographic abnormalities do not correlate disease severity and a normal radiograph does not exclude PH. The following signs on a frontal chest radiograph may indicate PH: Cardiac enlargement– usually caused by right ventricular enlargement, which appears as an...

Conclusion

It is essential for the radiologist to be familiar with the different manifestations of PH in order to help in the work-up and be a relevant part in the multidisciplinary team managing this disease.

Personal information

References

1.Galiè N, Humbert M, Vachiery J-L, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.Eur Heart J. 2016;37(1):67-119. doi:10.1093/eurheartj/ehv317 2.Peña E, Dennie C, Veinot J, Muñiz SH. Pulmonary Hypertension: How the Radiologist Can Help.RadioGraphics. 2012. doi:10.1148/rg.321105232 3.Mortani Barbosa EJ, Gupta NK, Torigian DA, Gefter WB. Current role of imaging in the diagnosis and management of pulmonary hypertension.Am J Roentgenol. 2012;198(6):1320-1331. doi:10.2214/AJR.11.7366 4.Aluja Jaramillo F, Gutierrez FR, Díaz Telli FG, Yevenes Aravena S, Javidan-Nejad C, Bhalla S. Approach to Pulmonary Hypertension: From...