CT

Computed tomography (CT) of the chest is useful in the detection of mediastinal and hilar pathology suggesting rare causes of pulmonary hypertension such as sarcoidosis or fibrosing mediastinitis. A main pulmonary artery diameter of 29 mm or greater (fig. 1) has a sensitivity and specificity of 84 % and 75 % for predicting pulmonary hypertension. The corresponding values for presence of an artery-to-bronchus ratio of 1 or greater in at least 3 lobes (fig. 2) are 65 % and 78 %. The presence of both conditions has a specificity of 100 %.

     
fig. 1
     fig. 2

     

 
fig. 4

fig. 3
      


High-resolution CT has an accuracy of about 90 % for the diagnosis of sarcoidosis and almost 100 % for the diagnosis of Langerhans-cell histiocytosis, which both can manifest as severe pulmonary hypertension, the latter almost invariably. The most important pattern is the presence of thickened interlobular septa, which in the absence of left heart failure suggests veno-occlusive disease (fig. 3).

A feature suggestive of CTEPH, but also occurring in PPH, is a mosaic perfusion of the lung parenchyma (fig. 4) often erroneously interpreted as ground-glass opacities of infiltrative lung diseases or obliterative bronchiolitis. The latter can be distinguished from pulmonary hypertension by the presence of air-trapping in expiratory images.

The usefulness of helical CT angiography in the evaluation of patients with CTEPH is still controversial. Central vessel disease can be documented as satisfactory as by conventional angiography. However, unlike in acute pulmonary embolism, contrast material can be visible in the segmental vessels involved in chronic thromboembolism because of recanalization. Because surgically accessible disease may begin distal lobar and proximal segmental, the decreased sensitvity of CT at this level may limit its usefulness in establishing the surgical candidacy in up to 20 % of patients. On the other hand, CT angiographic evidence of extensive central vessel disease and limited small vessel involvement indicates a favorable surgical outcome.

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SGPH-Symposium, 2. September 2010, Hotel Bristol in Genf:
"Hypertension artérielle pulmonaire: Comment ne pas passer à côté d’une maladie émergente?"  Mehr

 

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Helfen Sie uns, den Bereich "Patienten" weiter zu verbessern und Ihren Ansprüchen anzupassen indem Sie an unserer Umfrage teilnehmen.

 

Vereinsgründung:

Schweizer PH-Verein für Menschen mit pulmonaler Hypertonie gegründet. Pressemitteilung PDF

Next SSPH Workshop: October 28th, 2010
Haus der Universität in Berne, details will follow.

SSPH Workshop 2010: May 7-8, 2010

The SSPH workshop on May 7-8, 2010 in Lucerne did consist of an update of the website with the following topics:

  • Diagnosis
  • Treatment
  • Follow-up
  • Patients part

Many thanks to all the participants: The workshop from 7-8 May 2010 was a succesfull event, a lot of precious work has been done. Adaptations of the website content will soon be online.

 

4th international Congress of the SSPH

October 30 - 31, 2009



Link to the congress presentations as video streaming on swiss-webconferencing.ch .

Link to the congress photo-gallery

 

 



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