CTICasesPulmonary Arterial Hypertension (Group 1) in Elderly Patient
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Imaging findings
Chest x-ray shows a large, dilated pulmonary artery, prominent right-sided heart, and possible vascular congestion with a trace right pleural effusion. CT demonstrates significantly dilated main, left, and right pulmonary arteries, with disproportionate dilation of the right-sided cardiac chambers compared to the left. The inferior vena cava (IVC) is also dilated. Pulmonary windows reveal interstitial septal thickening, thickened bronchovascular bundles, and a mosaic attenuation pattern. Prominent pleural lines, particularly at the bases, are observed.
Key takeaways
Idiopathic pulmonary arterial hypertension (Group 1 PAH) is increasingly recognized in elderly populations, challenging the classical demographics. Imaging features include dilated pulmonary arteries, right heart chambers, and signs of interstitial edema (septal thickening, pleural effusions) which can overlap with pulmonary veno-occlusive disease (PVOD) or diastolic dysfunction. Clinical correlation and cardiac catheterization are crucial for diagnosis, but catheterization can be imprecise in the elderly due to multiple comorbidities. Lack of response to PAH-specific vasodilators like sildenafil can indicate a more complex multifactorial pulmonary hypertension.
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