title: Diagnostic Evaluation of Chronic Thromboembolic Pulmonary Hypertension.
abstract: Pulmonary hypertension is defined by a mean pulmonary artery pressure greater than 25 mm Hg. Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as pulmonary hypertension in the presence of an organized thrombus within the pulmonary vascular bed that persists at least 3 months after the onset of anticoagulant therapy. Because CTEPH is potentially curable by surgical endarterectomy, correct identification of patients with this form of pulmonary hypertension and an accurate assessment of surgical candidacy are essential to provide optimal care. Patients most commonly present with symptoms of exertional dyspnea and otherwise unexplained decline in exercise capacity. Atypical chest pain, a nonproductive cough, and episodic hemoptysis are observed less frequently. With more advanced disease, patients often develop symptoms suggestive of right ventricular compromise. Physical examination findings are minimal early in the course of this disease, but as pulmonary hypertension progresses, may include nonspecific finding of right ventricular failure, such as a tricuspid regurgitation murmur, pedal edema, and jugular venous distention. Chest radiographs may suggest pulmonary hypertension, but are neither sensitive nor specific for the diagnosis. Radioisotopic ventilation-perfusion scanning is sensitive for detecting CTEPH, making it a valuable screening study. Conventional catheter-based pulmonary angiography retains an important role in establishing the presence and extent of chronic thromboembolic disease. However, computed tomographic and magnetic resonance imaging are playing a growing diagnostic role. Innovative technologies such as dual-energy computed tomography, dynamic contrast-enhanced magnetic resonance imaging, and optical coherence tomography show promise for contributing diagnostic information and assisting in the preoperative characterization of patients with CTEPH.
authors: 1 Department of Radiology, Cambridge University Hospital, Cambridge and Imperial College Hospitals, London, United Kingdom; and.
authors: Deepa
authors: D
authors: Gopalan
authors: 2 Division of Cardiovascular Medicine and.
authors: Daniel
authors: D
authors: Blanchard
authors: 3 Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, San Diego, California.
authors: William R
authors: WR
authors: Auger
mesh_terms: D000792:Angiography; D002908:Chronic Disease; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D055420:Perfusion Imaging; D000072078:Positron Emission Tomography Computed Tomography; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000150:complications* / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic; D041623:Tomography, Optical Coherence; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging*
keywords: CTEPH; chronic thromboembolic disease; pulmonary embolism; pulmonary hypertension; thromboembolic disease