CTICasesPulmonary Arterial Hypertension with Systemic-to-Pulmonary Collateral Vessels
Imaging findings
CT shows massively dilated main and central pulmonary arteries with a markedly enlarged right ventricle consistent with severe pulmonary arterial hypertension. Multiple systemic vessels are identified supplying the pulmonary circulation including phrenic vessels, sinoatrial nodal branches, intercostal arteries, bronchial arteries, and internal mammary arteries. There is also a perivascular ground-glass blush or haziness centered around the pulmonary arteries that has been attributed to cholesterol granulomas, and this is a recognized finding in severe pulmonary hypertension.
Key takeaways
Severe pulmonary arterial hypertension can result in the development of extensive systemic-to-pulmonary collateral vessels from multiple sources including phrenic, sinoatrial nodal, intercostal, bronchial, and internal mammary arteries. The CT demonstration of these collaterals is important for understanding the disease hemodynamics and for planning interventions. The perivascular ground-glass blush seen in some cases of pulmonary hypertension is thought to represent cholesterol granulomas or other parenchymal changes secondary to high pulmonary arterial pressures.
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