Presentation
Worsening breathlessness. PHx pulmonary thrombectomy 5y prior
Patient Data
Age: 70 years
Gender: Male
From the case:
Chronic thromboembolic pulmonary hypertension
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No acute pulmonary embolism.
Eccentric mural thickening/thrombus in the distal main pulmonary arteries and lower lobar arteries.
Left lower lobe anteromedial segment pulmonary artery web.
Non-opacification of multiple segmental pulmonary arteries:
- right middle lobe lateral segment
- right lower lobe superior and posterior segments
- left upper lobe inferior lingula segment
- left lower lobe posterior and lateral segments
The main pulmonary trunk and the right heart are dilated suggestive of pulmonary arterial hypertension.
Bilateral lower lobe subpleural pulmonary scarring.
Case Discussion
The characteristic findings of CTEPH on CTPA are:
- eccentric wall-adherent thrombi
- vascular webs
- complete occlusion (every segment needs to be accounted for when reviewing the pulmonary arteries, otherwise this can easily be missed)
- dilated main pulmonary arteries and right heart
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