High resolution CT scans of the thorax are important to exclude the presence of parenchymal lung disease such as emphysema or interstitial lung disease. They may also lead to specific PH diagnoses such as pulmonary veno-occlusive disease (PVOD) [thickened interlobular septa, lymphadenopathy, pleural effusions and centrilobular ground glass nodules] or chronic thromboembolic pulmonary hypertension (CTEPH) [mosaicism and peripheral parenchymal opacities]. Ground glass changes are also seen in some people with PAH.
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.
- Resten A, Maitre S, Humbert M, Rabiller A, Sitbon O, Capron F, Simonneau G, Musset D. Pulmonary hypertension: CT of the chest in pulmonary veno-occlusive disease. Am J Roentgenol 2004;183:65–70.
- 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