A Female Presenting With Exertion Dyspnoea (Known Case Of Pulmonary Hypertension)

X-Ray Chest Frontal.

CT Axial C+ CTPA

CT Coronal C + CTPA

Case Discussion:

This patient has known idiopathic pulmonary hypertension, and her imaging shows well the typical appearances.  There is massive enlargement of the pulmonary trunk and the right and left main pulmonary arteries with abrupt pruning of the peripheral pulmonary arteries.  There is also mural calcification of the pulmonary trunk (best seen on the plain film), in keeping chronic pulmonary hypertension. CT shows bowing of the interventricular septum to the left.

Idiopathic pulmonary hypertension is essentially a diagnosis of exclusion.  The differential is that of causes of secondary pulmonary hypertension and includes among others:

• emphysema
• cystic fibrosis
• chronic pulmonary emboli
• chronic left to right shunt