40 year old lady was admitted and found to have severe pulmonary hypertension. A radiograph was taken on admission following which CT was requested to rule out acute or chronic pulmonary thromboembolism. The doppler study of both lower limbs did not reveal any deep venous thrombosis.
- cardiomegaly with elevated cardiac apex
- enlarged right atrium
- dense bilateral hilum with positive hilum convergence sign
- obliteration of left pulmonary bay
CTPA – CT pulmonary angiogram
- incidental azygos lobe
- dilated main pulmonary artery and both right and left pulmonary arteries.
- pruning of peripheral pulmonary vessels
- no acute or chronic pulmonary thromboembolism
- right sided cardiomegaly with RV:LV ratio >1
- dilated right atrium
- straightened interventricular septum with mild bowing to left ventricle
It is important to understand the pathophysiology of pulmonary hypertension, possible imaging findings to come to understanding the severity of PAH as well as other mimics.
I am including a presentation I adapted from a radiographics article during my residency for a better understanding.