CTICasesMosaic Perfusion in Chronic Thromboembolic Pulmonary Hypertension
Imaging findings
Inspiratory CT chest shows a classic mosaic perfusion pattern. An expiratory CT protocol demonstrates that the hyperlucent, pruned vascular regions increase in attenuation (get denser) on expiration, with no evidence of air trapping.
Key takeaways
Mosaic attenuation can be caused by small airways disease (air trapping) or vascular perfusion abnormalities (like CTEPH). Expiratory CT is the key diagnostic tool: in vascular diseases, the lucent lung regions will still increase in density on expiration because the airways are patent, whereas in airway disease, the lucent regions show no change in density.
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