Chronic thromboembolic pulmonary hypertension (CTEPH)
Clinical presentation: Patient often complaining of dyspnea on exertion, chest pain, cough and syncope. High risk patients: Cancer patient; chronic cardiac or pulmonary disease and clotting disorders. Imaging manifestations: Chest radiography would be normal early in the course of the development of CTEPH; later on there will be enlargement of the pulmonary arteries. Subpleural opacities representing recent or remote pulmonary infarction may be encountered. CTPA: The study of choice. Enlarged pulmonary artery. Eccentric filling defects representing organizing thrombi. Linear intraluminal filling defects representing intravascular webs. Abrupt narrowing of the pulmonary arteries with reduction in the arterial diameter. Markedly hypertrophied bronchial arteries. Right ventricular enlargement and hypertrophy. HRCT: Mosaic perfusion. Small foci of subpleural scarring related to prior pulmonary infarction. Enlarged ...