Learning objectives
1. To describe multimodality imaging techniques of CTEPH including important imaging findings.
2. To outline curative Treatment options available in the tertiary specialist centres.
Background
Chronic thromboembolic pulmonary hypertension (CTEPH) remains underdiagnosed despite recent huge advancements in imaging technologies. Under-diagnosis may relate to subtle imaging findings or radiologist's unfamiliarity with imaging features. Understanding of the common radiological findings and mimics are critical since amongst diverse causes of pulmonary hypertension, CTEPH is probably the only potentially curable form. With the advent of new therapies, there is improvement of both quality of life and life expectancy. Therefore, it is crucial that diagnosis is established early and curative treatment offered to reduce morbidity...
Findings and procedure details
Imaging Modalities:
Plain chest radiograph: May be normal at early CTEPH but bilateral hilar enlargement and cardiomegaly are usual findings. The lung parenchyma may appear normal or if abnormal there may be nonspecific peripheral scarring/atelectasis or more specific peripheral wedge-shaped opacity suggesting infarcts.
Echocardiogram: Is crucial for initial assessment to estimate systolic pulmonary arterial pressure, right heart changes from the tricuspid regurgitant jet and to evaluate right ventricular function. A firm diagnosis of pulmonary hypertension is only established invasively at right heart catheterisation.
Ventilation perfusion...
Conclusion
Accurate and early diagnosis of CTEPH will have enormous impact on management of patients particularly for cases potentially surgically treatable. Therefore, it is important for the radiologists to be aware of the multimodality approach, imaging findings and curative treatment options for symptomatic patients to improve quality of life and also to improve life expectancy.
Personal information and conflict of interest
S. Sultana:
Nothing to disclose
H. Çelik:
Nothing to disclose
T. H. Yu:
Nothing to disclose
I. Okam:
Nothing to disclose
L. L. D'Errico:
Nothing to disclose
A. Ruggiero:
Nothing to disclose
N. J. Screaton:
Nothing to disclose
References
Castaner E, Gallardo X, Ballesteros E, et al. CT diagnosis of chronic pulmonary thromboembolism. Radiographics 2009;29:31-53.
Jenkins D, Mayer E, Screaton N, Madani M. State-of-the-art chronic thromboembolic pulmonary hypertension diagnosis and management. Eur Respir Rev [Internet]. 2012 Mar 1;21(123):32–9. Available from: http://err.ersjournals.com/cgi/doi/10.1183/09059180.00009211
Gopalan D, Delcroix M, Held M. Diagnosis of chronic thromboembolic pulmonary hypertension. Eur Respir Rev [Internet]. 2017;26(143).
Fedullo PF, Rubin KM, Auger WR, Channick RN. The natural history of acute and chronic thromboembolic disease: the search for the missing link. Eur Respir J...