Pulmonary vascular disease Flashcards
pulmonary artery hypertension
pulmonary arterial systolic pressure >25 mmHg at rest, >30 mmHg exercise
elevated pulmonary venous pressures
pulmonary capillary wedge pressure >18 mmHg
causes of pulmonary hypertension
chronic thromboembolic disease, chronic respiratory disease, chronic heart disease, idiopathic causes
WHO group pulmonary hypertension
Group 1: pulmonary arterial hypertension
Group 2: pulmonary venous hypertension
Group 3: pulmonary hypertension with chronic hypoxemia
Group 4: pulmonary hypertension due to chronic thrombembolic disease
Group 5: pulmonary hyeprtension due to miscellaenous disorders
Group 1: Pulmonary arterial hypertension (PAH).
Primary pulmonary hypertension (PPH) may be idiopathic or familial.
Congenital left-to-right shunts, such as atrial septal defect (ASD) and ventricular septal defect (VSD), may cause PAH and shunt reversal (Eisenmenger syndrome).
PAH may be caused by pulmonary venous or capillary involvement, such as pulmonary veno- occlusive disease and pulmonary capillary hemangiomatosis.
enlargement of central/main pulmonary arteries, peripheral taping
Group 2: Pulmonary venous hypertension.
Left-sided heart disease (left atrial, left ventricular, or mitral/aortic valve disease) may cause
elevated pulmonary venous pressure in chronic disease.
LVOT lesion, mitral stenosis, obstructing intraatrial tumor/thrombus
Group 3: Pulmonary hypertension associated with chronic hypoxemia.
COPD, interstitial lung disease, and sleep apnea can cause pulmonary hypertension in chronic
Group 5: Pulmonary hypertension due to miscellaneous disorders.
Sarcoidosis is a rare cause of pulmonary hypertension.
Compression of pulmonary vessels, which can be due to neoplasm, fibrosing mediastinitis, etc., may cause pulmonary hypertension.
increased mediastinal soft tissue with calcified lymph nodes
measurement for main pulmonary artery diameter
> 29 mm is pulmoanry hypertension or dilation greater than aortic root
Group 4: Chronic thromboembolic pulmonary hypertension
Characteristic imaging features are peripheral, eccentric filling defects (in contrast to acute emboli which tend to be central) in the pulmonary arterial tree. Fibrous strands are sometimes visible on cross-sectional imaging. Mosaic perfusion may be present.
• CTEPH may cause secondary corkscrew bronchial arteries that are tortuous and dilated.
• Treatment of CTEPH is surgical thromboendarterectomy (similar to carotid endarterectomy).
risks factors for PE
immobilization, malignancy, catheter, obesity, OFP, thrombophilia
diagnosing PE
Wells score D dimer (high negative predictive value) CT angiogram VQ CXR
PE vs CTEPH
PE: central intraluminal pulmonary artery filling defect; lodge at bifurctaions
chronic thromboembolic disease: eccentric circumferential filling defect
Fleischner sign
widening of pulmonary arteries due to clot; CXR
Hampton’s hump
wedge shaped peripheral opacity; pulmonary infarct
