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Evaluation of role of computed tomography (CT) in the diagnosis of pulmonary hypertension

Abstract

Introduction

Pulmonary hypertension (PH) has significant morbidity and mortality. Chest computed tomography (CT) scans are increasingly used in the evaluation of patients with dyspnea, including those with suspected PH.

Aim

The aim was to study the signs of PH shown by CT scans, and to correlate the data obtained with echocardiography in suspected patients with PH in a trial to select patients who are eligible for right-heart catheterization and to confirm the diagnosis of PH in those patients who cannot tolerate right-heart catheterization.

Patients and methods

This study included 60 patients (50 patients with pulmonary hypertension and 10 patients with no PH) aged 32–70 years. They underwent high-resolution CT (23 cases) and computed tomography pulmonary angiography (37 cases) using 16 multidetector computed tomography scanner for the evaluation of their pulmonary parenchyma and mediastinal structures to detect different diagnostic criteria, causes, associations, and complications of PH. All the 60 patients underwent echocardiography.

Results

The main pulmonary artery (MPA) was larger than 29mm in 94% of the echo-positive cases and in 30% of the echocardiography-negative cases. A more than 1 : 1 relationship between the segmental pulmonary artery and the bronchus in at least three pulmonary lobes was seen in 84% of positive cases and in none of the negative cases. A more than 1 : 1 relationship between the MPA and the aorta was seen in 80% of positive cases and in 20% of negative cases. Correlation between MPA diameter in CT and the pulmonary artery systolic pressure measured by echocardiography in all cases showed significant correlation, with a P value of up to 0.001.

Conclusion

Although right-heart catheterization is the gold standard for the measurement of pulmonary artery pressure, this procedure is not without risk and expense. Multidetector computed tomography (computed tomography pulmonary angiography or high resolution CT (HRCT) can reliably be used, in addition to echocardiography, for the routine evaluation of patients with PH.

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Correspondence to Shaimaa M. Abo Youssef MSc.

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Elgazzar, A.G., Elmahdy, M.AE., Elshazly, I.M. et al. Evaluation of role of computed tomography (CT) in the diagnosis of pulmonary hypertension. Egypt J Bronchol 10, 310–318 (2016). https://doi.org/10.4103/1687-8426.193632

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  • DOI: https://doi.org/10.4103/1687-8426.193632

Keywords

  • computed tomography
  • echocardiography
  • main pulmonary artery