Abstract

Pulmonary hypertension due to chronic recurrent pulmonary embolism

posted by Thorsten R. C. Johnson, M.D. | May 7, 2008

History

A 72-year-old female patient suffering from severe dyspnea is referred for pulmonary CT angiography to rule out pulmonary embolism.

Question

CT angiography is performed to rule out pulmonary embolism, right heart dilatation or pulmonary hypertension.

Diagnosis/Differential diagnosis

Apart from acute pulmonary embolism, differential diagnoses include primary right heart failure, secondary pulmonary hypertension, congestive heart failure, coronary artery disease, pneumonia and pneumothorax.

Findings

Clots of pulmonary emboli are displayed in the main pulmonary artery. However, there are no occlusive emboli shown in the lobar or segmental arteries. The peripheral parenchyma shows a normal perfusion without segmental defects.

Comments

Dual energy CT can depict functional lung tissue in which both air and iodine are present and which can therefore be assumed to participate in blood oxygenation. In this patient, pulmonary embolism is present, but presumably old and it does not cause a perfusion defect, i.e. it is not impeding blood oxygenation.

[1] Sagittal view of the lung with normal perfusion.	[2] Coronal view with normal lung perfusion and thrombus clot in the central pulmonary artery on the right side.