In addition to demonstrating findings suggestive of PH, chest CT can also characterize various pulmonary etiologies that cause PH, including IPAH, pulmonary capillary hemangiomatosis (PCH), pulmonary veno-occlusive disease (PVOD), and many diffuse lung diseases. IPAH is characterized by plexiform lesions, which are networks of capillary-like channels in the wall of a dilated muscular PA that appear as ground glass centrilobular nodules. IPAH findings on CT include dilated central pulmonary arteries, centrilobular ground glass nodules associated with enlarged tortuous centrilobular arterioles, and pericardial effusion [21,46]. PCH, a diffuse proliferation of capillaries in the pulmonary interstitium, and PVOD, a disease of pulmonary venous hypertension secondary to pulmonary vein intimal fibrosis and subsequent venous occlusion, are rare diseases whose diagnosis can be suggested by findings on CT. On CT, PCH will have enlarged pulmonary arteries, centrilobular ground glass nodules, and interlobular septal thickening. PVOD presents on CT with enlarged pulmonary arteries, lymphadenopathy, pleural effusion, and interlobular septal thickening in the setting of a normal size left atrium. Surgical biopsy is necessary to confirm the diagnosis of PCH and PVOD [46-48]. Suspected Pulmonary Hypertension uncommon finding in PH, has also been reported at CTA [52,53]. As with chest CT, evaluation with RHC remains necessary to confirm PH suspected on CTPA before initiating therapy [24]. MRI Heart Function and Morphology MRI can also noninvasively assess the MPA and right ventricle for PH with good sensitivity and specificity (92% and 80%, respectively) and is useful for RV morphology and function assessment.
Suspected Pulmonary Hypertension. In addition to demonstrating findings suggestive of PH, chest CT can also characterize various pulmonary etiologies that cause PH, including IPAH, pulmonary capillary hemangiomatosis (PCH), pulmonary veno-occlusive disease (PVOD), and many diffuse lung diseases. IPAH is characterized by plexiform lesions, which are networks of capillary-like channels in the wall of a dilated muscular PA that appear as ground glass centrilobular nodules. IPAH findings on CT include dilated central pulmonary arteries, centrilobular ground glass nodules associated with enlarged tortuous centrilobular arterioles, and pericardial effusion [21,46]. PCH, a diffuse proliferation of capillaries in the pulmonary interstitium, and PVOD, a disease of pulmonary venous hypertension secondary to pulmonary vein intimal fibrosis and subsequent venous occlusion, are rare diseases whose diagnosis can be suggested by findings on CT. On CT, PCH will have enlarged pulmonary arteries, centrilobular ground glass nodules, and interlobular septal thickening. PVOD presents on CT with enlarged pulmonary arteries, lymphadenopathy, pleural effusion, and interlobular septal thickening in the setting of a normal size left atrium. Surgical biopsy is necessary to confirm the diagnosis of PCH and PVOD [46-48]. Suspected Pulmonary Hypertension uncommon finding in PH, has also been reported at CTA [52,53]. As with chest CT, evaluation with RHC remains necessary to confirm PH suspected on CTPA before initiating therapy [24]. MRI Heart Function and Morphology MRI can also noninvasively assess the MPA and right ventricle for PH with good sensitivity and specificity (92% and 80%, respectively) and is useful for RV morphology and function assessment.