CTICasesChronic Thromboembolic Pulmonary Hypertension (CTEPH) with Cavitary Pulmonary Infarctions
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Imaging findings
Contrast-enhanced chest CT shows findings of severe pulmonary hypertension, including enlargement of the right ventricle, flattening of the interventricular septum, dilation of the right atrium and suprahepatic inferior vena cava, and dilation of the main and proximal pulmonary arteries. The lung windows reveal classic, dramatic mosaic perfusion with geographic areas of ground-glass opacity showing significantly dilated vessels, while the oligemic areas show very small vessels. Additionally, there are pleural-based, cavitary pulmonary infarctions in the lower lobes with feeding vessels running directly into the lesions.
Key takeaways
Chronic thromboembolic pulmonary hypertension (CTEPH) leads to marked mosaic perfusion, which is characterized by hyperperfused lung zones with dilated vessels adjacent to hypoperperfused zones with pruned vessels. Cavitary infarctions can occur in the setting of chronic thromboembolism, and the presence of a central intracavitary focus should raise suspicion for a developing mycetoma (saprophytic colonization).
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