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



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.


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.


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.


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.


  1. Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol 2013;62:D42–D50.

    Article  Google Scholar 

  2. Andersen KH, Iversen M, Kjaergaard J, Mortensen J, Nielsen-Kudsk JE, Bendstrup E et al. Prevalence, predictors, and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease. J Heart Lung Transplant 2012;31:373–380.

    Article  Google Scholar 

  3. Bossone E, Bodini BD, Mazza A, Allegra L. Pulmonary arterial hypertension: the key role of echocardiography. Chest 2005;127: 1836–1843.

    Article  Google Scholar 

  4. Fisher MR, Forfia PR, Chamera E, Housten-Harris T, Champion HC, Girgis RE et al. Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med 2009;179:615–621.

    Article  Google Scholar 

  5. Ng CS, Wells AU, Padley SP. A CT sign of chronic pulmonary arterial hypertension: the ratio of main pulmonary artery to aortic diameter. J Thorac Imaging 1999;14:270–278.

    Article  CAS  Google Scholar 

  6. Grosse C, Grosse A. CT findings in diseases associated with pulmonary hypertension: a current review. Radiographics 2010;30:1753–1777.

    Article  Google Scholar 

  7. Peña E, Dennie C, Veinot J, Muñiz SH. Pulmonary hypertension: how the radiologist can help. Radiographics 2012;32:9–32.

    Article  Google Scholar 

  8. Tsai IC, Tsai WL, Wang KY, Chen MC, Liang KW, Tsai HY, Liao WC. Comprehensive MDCT evaluation of patients with pulmonary hypertension: diagnosing underlying causes with the updated Dana Point 2008 classification. Am J Roentgenol 2011;197: W471–W481.

    Article  Google Scholar 

  9. Sabri YY, Hamdy IM, Sabry IM, Assad A, Al-Hadi S. Studying the signs of pulmonary hypertension shown by CT scans and correlating data obtained with echocardiography in suspected patients of pulmonary hypertension. Egypt J Bronchol 2013;7:60–66.

    Article  Google Scholar 

  10. European Society of Cardiology (ESC), European Respiratory Society (ERS). ESC/ERS 2009 Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009;30:2493–2537.

    Google Scholar 

  11. Devaraj A, Wells AU, Meister MG, Corte TJ, Wort SJ, Hansell DM. Detection of pulmonary hypertension with multidetector CT and echocardiography alone and in combination. Radiology 2010; 254:609–616.

    Article  Google Scholar 

  12. Jassal D, Lin EC, Sharma S, Maycher B, Coombs BD et al. Pulmonary hypertension imaging. XX 2015. accessed on:

  13. Schiebler M, Bhalla S, Runo J, Jarjour N, Roldan A et al. MR and CT imaging of the structural and functional changes of pulmonary arterial hypertension. J Thorac Imaging 2013;28:178–193.

    Article  Google Scholar 

  14. Truong QA, Massaro JM, Rogers IS, Mahabadi AA, Kriegel MF et al. Reference values for normal pulmonary artery dimensions by noncontrast cardiac computed tomography: the Framingham Heart Study. Circ Cardiovasc Imaging 2012;5:147–154.

    Article  Google Scholar 

  15. Murray TI, Boxt LM, Katz J, Reagan K, Barst RJ. Estimation of pulmonary artery pressure in patients with primary pulmonary hypertension by quantitative analysis of magnetic resonance images. J Thorac Imaging 1994;9:198–204.

    Article  CAS  Google Scholar 

  16. Mao SS, Ahmadi N, Shah B, Beckmann D, Chen A, Ngo L et al. Normal thoracic aorta diameter on cardiac computed tomography in healthy asymptomatic adult; impact of age and gender. Acad Radiol 2008;15:827–834.

    Article  Google Scholar 

  17. Pérez-Enguix D, Morales P, Tomás JM, Vera F, Lloret RM. Computed tomographic screening of pulmonary arterial hypertension in candidates for lung transplantation. Transplant Proc 2007;39:2405–2408.

    Article  Google Scholar 

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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).

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