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Pulmonary MRA and perfusion study clearly demonstrate left upper lobe pulmonary artery occlusion and right lower lobe segmental stenoses. Multiple segmental and subsegmental stenoses are also discernible within the right upper and left lower lobes. Systemic vessel from the left chest wall and bronchial artery branches supply the underperfused pulmonary lobes. These features are not demonstrated as well via CTPA
Right ventricular hypertrophy with septal bowing to the left indicates development of associated pulmonary hypertension.