CTICasesChronic Thromboembolic Pulmonary Hypertension (CTEPH) with Resolution Post-Endarterectomy
Imaging findings
The initial radiograph reveals pulmonary hypertension with dilated pulmonary arteries. A lung perfusion scan demonstrates multiple segmental perfusion abnormalities, predominantly in the lower lobes. CT imaging shows mosaic attenuation, particularly pronounced in the lower lung zones, characterized by areas of hypoattenuating lung and conspicuously small, narrowed, and irregularly narrowed proximal segmental arteries of the lower lobes. Bronchial dilatation is also present in regions of mosaic perfusion. Following pulmonary endarterectomy, a subsequent CT scan shows remarkable opening of the previously narrowed vessels, which now appear significantly larger and perfusing well, accompanied by substantial improvement in both mosaic attenuation and bronchial dilatation. The right atrium and ventricle also demonstrate a decrease in size.
Key takeaways
Chronic Thromboembolic Pulmonary Hypertension (CTEPH) manifests with pulmonary arterial hypertension, mosaic attenuation, small distal pulmonary arteries, and segmental perfusion defects. Bronchial dilatation can be a co-occurring finding. Pulmonary endarterectomy can lead to a dramatic resolution of these imaging features, including the restoration of vessel caliber, normalization of mosaic attenuation, and reduction in right heart chamber size, thereby underscoring the effectiveness of the procedure.
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