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Radiological Diagnosis of
Pulmonary Hypertension
Fatema Ali Al-Khater
210007782
Radiographic Features
Plain X-Ray
By the time the diagnosis of
pulmonary arterial hypertension is made,
90% of patients have an abnormal chest
radiograph ....
-elevated cardiac apex due to
right ventricular hypertrophy.
-enlarged right atrium.
-prominent pulmonary
outflow tract.
-...
Comment on the pulmonary artery
The X-ray shows gross enlargement of the cardiac shadow. The right border
extends far to the right indicating gross right ...
Lateral chest radiograph shows filling of the retrosternal airspace
(arrow), a result of right ventricular dilatation.
Chest radiograph reveals enlargement of the pulmonary
vasculature and the central pulmonary arteries (arrows).
Secondry hypertension By atrial septal defect
Lateral CXR of the same patient, showing
enlarged pulmonary artery.
Cardiomegaly and prominent bilateral pulmonary arteries in the
hilar areas can be seen in the posteroanterior chest radiog...
Computed Tomography
1- CT is good , noninvasive , used to
confirm presence of pulmonary
hypertension.
2- It is useful in delineating the anato...
PH signs on CT
Extr-acardiac
Cardiacparenchymal
Enlarged pulmonary trunk >29 mm diameter is
often used as a general predictive cut-off
Enlarged pulmonary arteries
Mural c...
T angiogram shows dilatation (29 mm or more) of
the main pulmonary artery.
Axial contrast-enhanced CT scan ,shows central pulmonary
artery dilatation with aneurysmal enlargement of the left lower
l...
-Right ventricular hypertrophy: defined as wall
thickness of more than 4 mm.
-Straightening or bowing (towards the left
ve...
right ventricular myocardium (white arrow) is more than 4
mm thick. Straightening of the interventricular septum
(black ar...
right ventricular dilatation, which is defined as a diameter ratio (the ratio
of the right ventricular diameter [black arr...
reflux of contrast material into the inferior vena cava,
which is dilated, and hepatic veins
Centrilobular ground-glass nodules (Cholesterol
granuloma).
Neovascularity: tiny serpiginous intrapulmonary
vessels that o...
Axial contrast-enhanced CT scan shows corkscrewlike
peripheral pulmonary arteries (arrows), findings
indicative of plexoge...
Axial contrast-enhanced CT scan shows an eccentric wall-
adherent thrombus (arrow) in the right interlobar
pulmonary arter...
Axial contrast-enhanced CT scan shows:
-right atrial and ventricular enlargement with inverted interventricular
septum
- r...
Axial contrast-enhanced CT scan shows a thrombotic
mass (straight arrows) in the right main pulmonary
artery.
Echocardiography
- It’s performed to estimate the pulmonary artery
systolic pressure and to assess right ventricular size,
thickness, and f...
1. Right ventricular enlargement
(RVE).
2. Right ventricular hypertrophy
(RVH).
3. Right atrial enlargement
(RAE).
4. Func...
The short axis view from a 2-D echocardiogram shows
significant right ventricular pressure and volume
overload as a result...
The short axis view from a 2-D echocardiogram shows
significant right ventricular pressure and volume overload as
a result...
Angiography
Right heart catheterization may be
required.
-Pulmonary angiography is the most
accurate modality for evaluating the
anat...
Selective right pulmonary arteriogram demonstrates large central
pulmonary arteries and attenuation of the peripheral vess...
Pulmonary hypertension. Selective left pulmonary arteriogram
reveals large central pulmonary arteries and attenuation of t...
Angiograms showing a healthy pulmonary artery (left) and a
pulmonary artery with numerous blockages (right).
Magnetic resonance
Imaging
The disadvantages with MRI:
-include limitations in individuals with cardiac-
pacemakers and defibrillators.
- its limited...
Cardiac MRI showing dilated right ventricle
(Axial View )
Cardiac MRI showing dilated right
ventricle (Sagittal view).
Magnetic Resonance Angiography
from a patient with PH
Magnetic Resonance Angiography in patient with Chronic
Thromboembolic Pulmonary Hypertension.
-The main radiological features in Diagnosis
of pulmonary Hypertension in :
-plain –X-Ray.
-Computed tomography.
-Echocard...
References
Thank you
Any Question?
Fatema al khater
Fatema al khater
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Radiological findings of pulmonary Hypertension

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  1. 1. Radiological Diagnosis of Pulmonary Hypertension Fatema Ali Al-Khater 210007782
  2. 2. Radiographic Features
  3. 3. Plain X-Ray
  4. 4. By the time the diagnosis of pulmonary arterial hypertension is made, 90% of patients have an abnormal chest radiograph . -low sensitivity and specificity. Plain film
  5. 5. -elevated cardiac apex due to right ventricular hypertrophy. -enlarged right atrium. -prominent pulmonary outflow tract. -enlarged pulmonary arteries. -pruning of peripheral pulmonary vessels. (+ve) Findings :
  6. 6. Comment on the pulmonary artery
  7. 7. The X-ray shows gross enlargement of the cardiac shadow. The right border extends far to the right indicating gross right atrial enlargement
  8. 8. Lateral chest radiograph shows filling of the retrosternal airspace (arrow), a result of right ventricular dilatation.
  9. 9. Chest radiograph reveals enlargement of the pulmonary vasculature and the central pulmonary arteries (arrows).
  10. 10. Secondry hypertension By atrial septal defect
  11. 11. Lateral CXR of the same patient, showing enlarged pulmonary artery.
  12. 12. Cardiomegaly and prominent bilateral pulmonary arteries in the hilar areas can be seen in the posteroanterior chest radiograph
  13. 13. Computed Tomography
  14. 14. 1- CT is good , noninvasive , used to confirm presence of pulmonary hypertension. 2- It is useful in delineating the anatomic detail of the pulmonary vasculature. 3-CTPA is the best method for demonstrating emboli. 4- Contrast-enhanced images may show intraluminal abnormalities in the arteries and veins and can detect emboli if it’s large. Advantages of CT
  15. 15. PH signs on CT Extr-acardiac Cardiacparenchymal
  16. 16. Enlarged pulmonary trunk >29 mm diameter is often used as a general predictive cut-off Enlarged pulmonary arteries Mural calcification in central pulmonary arteries Evidence of previous pulmonary emboli Extra-cardiac vascular signs:
  17. 17. T angiogram shows dilatation (29 mm or more) of the main pulmonary artery.
  18. 18. Axial contrast-enhanced CT scan ,shows central pulmonary artery dilatation with aneurysmal enlargement of the left lower lobe pulmonary artery .
  19. 19. -Right ventricular hypertrophy: defined as wall thickness of more than 4 mm. -Straightening or bowing (towards the left ventricle) of the interventricular septum - Right ventricular dilatation - Decreased right ventricular ejection fraction - Dilatation of the inferior vena cava and hepatic veins - Pericardial effusion Cardiac signs :
  20. 20. right ventricular myocardium (white arrow) is more than 4 mm thick. Straightening of the interventricular septum (black arrow) also is seen.
  21. 21. right ventricular dilatation, which is defined as a diameter ratio (the ratio of the right ventricular diameter [black arrow] to the left ventricular diameter [white arrow]) greater than 1:1 at the midventricular level.
  22. 22. reflux of contrast material into the inferior vena cava, which is dilated, and hepatic veins
  23. 23. Centrilobular ground-glass nodules (Cholesterol granuloma). Neovascularity: tiny serpiginous intrapulmonary vessels that often emerge from centrilobular arterioles. Parenchymal signs:
  24. 24. Axial contrast-enhanced CT scan shows corkscrewlike peripheral pulmonary arteries (arrows), findings indicative of plexogenic arteriopathy.
  25. 25. Axial contrast-enhanced CT scan shows an eccentric wall- adherent thrombus (arrow) in the right interlobar pulmonary artery .
  26. 26. Axial contrast-enhanced CT scan shows: -right atrial and ventricular enlargement with inverted interventricular septum - right ventricular hypertrophy, - -eccentric chronic thrombus causing a crescent-shaped intraluminal filling defect (arrow) in the left lower lobe pulmonary artery.
  27. 27. Axial contrast-enhanced CT scan shows a thrombotic mass (straight arrows) in the right main pulmonary artery.
  28. 28. Echocardiography
  29. 29. - It’s performed to estimate the pulmonary artery systolic pressure and to assess right ventricular size, thickness, and function. - evaluate right atrial size, left ventricular systolic and diastolic function, and valve function. - detecting pericardial effusions and intracardiac shunts. - uses Doppler ultrasound to estimate the pulmonary artery systolic pressure. Advantages
  30. 30. 1. Right ventricular enlargement (RVE). 2. Right ventricular hypertrophy (RVH). 3. Right atrial enlargement (RAE). 4. Functional tricuspid regurgitation (TR) with a high velocity regurgitant jet by Doppler (TR jet). 5. The interventricular septum is shifted toward the left ventricular cavity. Main findings
  31. 31. The short axis view from a 2-D echocardiogram shows significant right ventricular pressure and volume overload as a result of pulmonary hypertension.
  32. 32. The short axis view from a 2-D echocardiogram shows significant right ventricular pressure and volume overload as a result of pulmonary hypertension.
  33. 33. Angiography
  34. 34. Right heart catheterization may be required. -Pulmonary angiography is the most accurate modality for evaluating the anatomy and pathophysiology of pulmonary hypertension -The disadvantage : it is an invasive procedure as one cannulates the right side of the heart and thea pulmonary artery.
  35. 35. Selective right pulmonary arteriogram demonstrates large central pulmonary arteries and attenuation of the peripheral vessels.
  36. 36. Pulmonary hypertension. Selective left pulmonary arteriogram reveals large central pulmonary arteries and attenuation of the peripheral vessels
  37. 37. Angiograms showing a healthy pulmonary artery (left) and a pulmonary artery with numerous blockages (right).
  38. 38. Magnetic resonance Imaging
  39. 39. The disadvantages with MRI: -include limitations in individuals with cardiac- pacemakers and defibrillators. - its limited availability and cost, and difficulty in assessing estimate PA pressures with MRI. MRI with contrast enhancement allows one to distinguish between the pulmonary vasculature and mediastinal adenopathy Advantages :
  40. 40. Cardiac MRI showing dilated right ventricle (Axial View )
  41. 41. Cardiac MRI showing dilated right ventricle (Sagittal view).
  42. 42. Magnetic Resonance Angiography from a patient with PH
  43. 43. Magnetic Resonance Angiography in patient with Chronic Thromboembolic Pulmonary Hypertension.
  44. 44. -The main radiological features in Diagnosis of pulmonary Hypertension in : -plain –X-Ray. -Computed tomography. -Echocardiography. -MRI. -Angiography. - Advantages / Disadvantages of each one . Summary
  45. 45. References
  46. 46. Thank you Any Question?

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