The CT pulmonary angiogram (CTPA) can suggest the presence of PH by morphological changes such as right heart enlargement, increased pulmonary artery (PA) diameter – relative to the aorta – the presence of significant tricuspid regurgitation and a pericardial effusion. It is useful in defining surgically treatable chronic thromboembolic disease, by showing features such as eccentric laminated thrombus, vessel amputation, webs, irregular vessels and bronchial artery dilatation.
Key scans from a CT Pulmonary Angiogram
Images courtesy of Dr M Sproule, Scottish Pulmonary Vascular Unit
Links to further reading:
- Rajaram S, Swift AJ, Condliffe R, Johns C, Elliot CA, Hill C, Davies C, Hurdman J,Sabroe I, Wild JM, Kiely DG. CT features of pulmonary arterial hypertension and its major subtypes: a systematic CT evaluation of 292 patients from the ASPIRE Registry. Thorax 2015;70:382–387.
- Heinrich M et al. CT findings in chronic thromboembolic pulmonary hypertension: predictors of haemodynamic improvement after pulmonary thromboendarterectomy. Chest 2005; 127:1606-13
- The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart Journal (2016) 37, 67–119
- Sproule, M. Chapter 8. Imaging. In Pulmonary Circulation. Diseases and their Treatment Ed Peacock et al. 2016. 138-152
- Auger WR et al. Evaluation of patients with chronic thromboembolic pulmonary hypertension for pulmonary endarterectomy. Pulmonary Circulation 2012; 2: 155-162.