CTICasesSevere Chronic Thromboembolic Pulmonary Hypertension (CTEPH) with Discordantly Near-Normal V/Q Scan
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Imaging findings
CT shows findings of severe pulmonary hypertension, including central pulmonary artery thrombi, webs, and stenoses, consistent with chronic pulmonary thromboembolism. Despite these findings, the perfusion and ventilation V/Q SPECT CT scan is near-normal, with only relatively small, non-wedge-shaped perfusion abnormalities. A patent foramen ovale (PFO) is also noted.
Key takeaways
In patients with chronic thromboembolic pulmonary hypertension (CTEPH), a near-normal V/Q scan does not exclude substantial central pulmonary artery pathology. This can occur if the peripheral vasculature is relatively spared, or if there is uniform elevation of pulmonary vascular resistance. V/Q scans reflect the relative distribution of pulmonary vascular resistances, which may not always correlate with the severity of central disease.
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