CTICasesChronic Thromboembolic Pulmonary Hypertension with Central Organized Clot
Imaging findings
A patient with pulmonary hypertension had CTA showing mildly enlarged central pulmonary vessels, a dilated hypertrophied right ventricle and right atrium, and prominent, heaped-up central calcified clot within the pulmonary arteries with associated near-complete occlusion of an upper lobe branch (only a thread of contrast getting through) and corresponding mosaic attenuation of the lung parenchyma, a classic appearance of chronic thromboembolic pulmonary hypertension (CTEPH) with recanalization.
Key takeaways
Central, calcified, heaped-up chronic clot in the pulmonary arteries with corresponding mosaic attenuation is a classic CT appearance of CTEPH and identifies a good surgical candidate for pulmonary thromboendarterectomy, since central disease is more surgically accessible than predominantly peripheral webs/disease; the degree of mosaic attenuation on CT can reliably predict the perfusion defects that will be seen on a subsequent VQ scan.
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