CT DIAGNOSTICS OF CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION. CLINICAL OBSERVATION

Abstract

The article, as an example of a clinical case, shows the importance of differential diagnosis of chronic thromboembolic pulmonary hypertension (CTPH) from other similar conditions. A 64 year old patient underwent computed tomography followed by intravenous bolus administration of a contrast medium (CT angiopulmonography). Diffuse changes in the pulmonary parenchyma on both sides were revealed according to the type of mosaic perfusion, the so called geographical pattern; fibrotic changes with the presence of numerous, mainly subpleural, parenchymal cords, which are directed from the pleura to the root of the right lung; chronic obstruction of the right pulmonary artery as a result of incomplete resolution of blood clots, leading to the formation of fibrosis with subsequent occlusion; the presence of systemic collateral transpleural blood flow from non bronchial arteries. Visualization of the changes during CT angiography has suggested that this patient is more likely to have CTPH with occlusion of the right pulmonary artery, with damage to the branches of the left pulmonary artery at the level of the lower lobe of the lung.