CTICasesInversion of Pulmonary Blood Flow in Mitral Valve Disease
Imaging findings
Chest radiograph and CT chest demonstrate marked enlargement of the upper lobe pulmonary veins and arteries compared to the lower lobe vessels (cephalization), in a patient with severe chronic mitral stenosis.
Key takeaways
Cephalization or inversion of pulmonary blood flow is a classic sign of chronic pulmonary venous hypertension. Elevated left atrial pressures lead to vasoconstriction in the dependent lower lobes and redistribution of blood flow to the upper zones, which is highly specific for chronic mitral valve disease or left heart failure.
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