CTICasesChronic Thromboembolic Pulmonary Hypertension (CTEPH) Post-Pulmonary Endarterectomy
Imaging findings
Pre-operative CT demonstrates signs of severe pulmonary hypertension, including right ventricular hypertrophy and dilation, septal flattening, and a massive pulmonary artery. Marked mosaic attenuation is present in the lung parenchyma due to distal arterial occlusions. Post-pulmonary endarterectomy CT shows a dramatic decrease in the size of the right ventricle, and the mosaic perfusion is nearly completely resolved, reflecting the restoration of homogenous distal blood flow.
Key takeaways
CTEPH is characterized by chronic fibrotic thrombi obstructing pulmonary arterial branches, leading to severe pulmonary hypertension and mosaic lung perfusion. Pulmonary endarterectomy is the treatment of choice, and successful surgical clearance of the vessels can be visualized post-operatively on CT by the normalization of right heart size and the dramatic resolution of mosaic perfusion patterns.
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