Pulmonary Arterial Hypertension

FIGURE 1.3. Ventilation-perfusion imaging in diagnosis of pulmonary embolism. A:Ventilation image, obtained with 99mTc pentetate aerosol, shows homogenous ventilation on posterior view. B: Matched perfusion image shows large (segmental) perfusion defects in the left mid lung, and in the lateral segment of the left lower lobe. There is also decreased perfusion in the right upper lobe. The presence of unmatched segmental abnormalities indicates a high probability for pulmonary embolism.

FIGURE 1.32. A 60-year-old man with pulmonary hypertension due to chronic liver disease. A: On the frontal chest radiograph, the main pulmonary artery is enlarged (arrow). The right interlobar pulmonary artery is enlarged, measuring 20 mm. The normal value is 17 mm (arrows). B: On the lateral view, the left pulmonary artery is enlarged, measuring 23 mm, compared with a normal value of 20 mm.

FIGURE 36.2. Bilateral pulmonary embolism (arrows) demonstrated by contrast-enhanced spiral computed tomography scan.

<bold>Figure 13.5</bold> Contrast enhanced multirow (16-slice) detector chest CT in a patient with acute pulmonary embolism. In the coronal reconstructed view, multiple segmental emboli can be visualized <italic>(arrows)</bold>. (Figure kindly provided by Joseph Schoepf, MD, Department of Radiology, Brigham and Women’s Hospital, Boston, MA.)

<bold>Figure 13.7</bold> Primary evidence of acute pulmonary embolism. Selective cut-film angiogram of the right lower lobe pulmonary artery with multiple intraluminal radiolucencies, almost completely outlined by contrast <bold>(left)</bold>. Corresponding segmental perfusion defects of the right lower lobe <bold>(right)</bold>.

<bold><i>FIGURE 7.49.</i></bold> In this patient, recurrent pulmonary emboli resulted in right ventricular (<i>RV</i>) enlargement and pulmonary hypertension. The increase in RV size is apparent in the parasternal long-axis <bold>(A)</bold> and four-chamber <bold>(B)</bold> views. <bold>C:</bold> Doppler recording of tricuspid regurgitation velocity confirms significant pulmonary hypertension. Ao, aorta; LA, left atrium; LV, left ventricle; RA...

<bold><italic>FIGURE 7.56.</bold></bold> A subcostal four-chamber view demonstrates hypertrophy of the right ventricular free wall (<italic>arrow</bold>) in a patient with pulmonary hypertension. Both right-sided chambers are dilated. RA, right atrium; RV, right ventricle.

<bold><italic>FIGURE 7.57.</bold></bold> From a patient with pulmonary hypertension, the apical four-chamber view <bold>(A)</bold> demonstrates a dilated right heart with evidence of right ventricular hypertrophy (<italic>arrows</bold>). Using the tricuspid regurgitation velocity <bold>(B)</bold>, the right ventricular systolic pressure is estimated to be 85 mm Hg. LV, left ventricle; RA, right atrium; RV, right ventricle.

Echocardiography in a patient with massive pulmonary embolism. The right ventricle (RV) is markedly enlarged, flattening the intraventricular septum and compromising the left ventricle (LV).

<bold>Figure 1.25. Ventilation-perfusion scan in a patient with pulmonary emboli. A.</bold> Perfusion scan of the lungs shows many areas devoid of radioisotope (photopenia) bilaterally. <bold>B.</bold> The ventilation scan is normal. This combination of findings is diagnostic of pulmonary embolism.

<bold>Fig C 1-22 Pulmonary infarction.</bold> (A) Chest film made 3 days after open-heart surgery demonstrates a very irregular opacity at the right base (pneumonia versus pulmonary embolization with infarction). (B) On a film made 5 days later, the consolidation is seen to have reduced in size yet to have retained the same general configuration as on the initial view. The diagnosis of pulmonary embolism was confirmed by a radionuclide lung scan.⁵

<bold>Fig CA 13-3 Cor pulmonale</bold> (primary pulmonary hypertension). (A) Frontal and (B) lateral views of the chest show prominence of the pulmonary outflow tract and markedly dilated central pulmonary vessels. The lateral displacement of the cardiac apex and filling of the retrosternal air space indicate right ventricular enlargement.

<bold>Fig CA 13-3 Cor pulmonale</bold> (primary pulmonary hypertension). (A) Frontal and (B) lateral views of the chest show prominence of the pulmonary outflow tract and markedly dilated central pulmonary vessels. The lateral displacement of the cardiac apex and filling of the retrosternal air space indicate right ventricular enlargement.

<bold><italic>Figure 14-12</bold> Pulmonary arteriole in pulmonary hypertension.</bold> High pulmonary vascular pressure injures the arterial wall and causes hyperplasia of cells in the wall of the artery.

<bold>FIGURE 11-27. Cor pulmonale.</bold> A transverse section of the heart from a patient with primary (idiopathic) pulmonary hypertension shows a markedly hypertrophied right ventricle (on the left). The right ventricular free wall has a thickness equal to the left ventricular wall. The right ventricle is dilated. The straightened interventricular septum has lost its normal curvature toward the left ventricle as part of the remodeling process in cor pulmonale.