CTICasesPulmonary Arterial Hypertension with Recurrent Hemoptysis
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Imaging findings
The chest radiograph shows big central pulmonary arteries, an enlarged and convex right ventricle, and enlarged main pulmonary arteries, highly suggestive of pulmonary hypertension. CT reveals a massively dilated and hypertrophied right ventricle, and dramatic mosaic attenuation throughout the lungs. The areas of increased attenuation (previously described as ground glass) are centrilobular and correspond to plexiform arteriopathy with numerous tiny, sprouted blood vessels and locally dilated pulmonary arteries/microaneurysms at the lobule centers. There are also generous hypertrophied bronchial arteries. An area of airspace opacity in the left upper lobe represents acute hemorrhage, while previous studies showed similar ground glass opacities in different locations associated with recurrent hemoptysis.
Key takeaways
Pulmonary arterial hypertension (PAH) leads to characteristic imaging findings including central pulmonary artery enlargement, right ventricular hypertrophy, and mosaic attenuation. The 'ground glass' areas in PAH are not always acute hemorrhage but can represent underlying plexiform arteriopathy with increased vascularity and small vessel abnormalities. Recurrent hemoptysis in PAH is often due to rupture of hypertrophied bronchial arteries, which develop as a compensatory mechanism.
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