An enlarged cardiac silhouette with prominent pulmonary trunk and pulmonary arteries proximally.
CT of the chest demonstrates enlarged bronchial arteries. The right atrium and right ventricle are significantly dilated with complete inversion of the intraventricular septum, which is now convex toward the left ventricle indicating significant pulmonary arterial hypertension.
The lungs demonstrate some cystic change peripherally, anteriorly and laterally, as well as multiple wedge shape but small pleural based consolidations presumably healing or healed pulmonary infarctions. The central main pulmonary artery shows significant irregularity although the wall thickening is not dramatic in keeping with laminated chronic embolism. There are peripheral changes of pulmonary embolism manifested by extensive eccentric bronchial wall thickening in the right lower lobe, abrupt termination of blood vessels in the left upper lobe and in the right upper lobe there is evidence of abrupt occlusion of vessels.
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