CTICasesInversion of Pulmonary Blood Flow in Mitral Regurgitation
Imaging findings
Chest radiograph and CT demonstrate massive left atrial enlargement. There is marked dilation of the upper lobe pulmonary veins and constriction of the lower lobe vessels, representing a classic pattern of inversion of pulmonary blood flow (cephalization).
Key takeaways
Chronic left atrial hypertension (such as from mitral stenosis or regurgitation) causes post-capillary pulmonary hypertension. This leads to redistribution of blood flow to the upper lobes (cephalization), which is easily appreciated on chest radiographs and CT by comparing the size of upper and lower lobe vessels.
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