Cardiac causes of pulmonary arterial hypertension: assessment with multidetector CT

The causes of pulmonary arterial hypertension (PAH) are diverse and include multiple congenital and acquired cardiac diseases as well as diseases primarily affecting the pulmonary vasculature, lung, pleura and chest wall. The traditional role of CT in evaluating PAH includes assessment of pulmonary...

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Bibliographic Details
Published in:European radiology 2009-11, Vol.19 (11), p.2557-2568
Main Authors: Hoey, Edward T. D., Gopalan, Deepa, Agrawal, S. K. Bobby, Screaton, Nicholas J.
Format: Article
Language:English
Subjects:
Angiography - methods
Cardiovascular disease
Catheters
Chest
Congenital diseases
Diagnostic Radiology
Electrocardiography
Heart
Heart Ventricles - diagnostic imaging
Hemodynamics
Humans
Hypertension, Pulmonary - diagnosis
Hypertension, Pulmonary - diagnostic imaging
Image Processing, Computer-Assisted
Imaging
Internal Medicine
Interventional Radiology
Lung - diagnostic imaging
Lung Diseases - diagnostic imaging
Medical imaging
Medical prognosis
Medicine
Medicine & Public Health
Mortality
Neuroradiology
Pulmonary arteries
Pulmonary Artery - diagnostic imaging
Pulmonary hypertension
Radiation
Radiology
Radiology - methods
Tomography, X-Ray Computed - methods
Ultrasound
Veins & arteries
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Summary:The causes of pulmonary arterial hypertension (PAH) are diverse and include multiple congenital and acquired cardiac diseases as well as diseases primarily affecting the pulmonary vasculature, lung, pleura and chest wall. The traditional role of CT in evaluating PAH includes assessment of pulmonary vasculature and lung parenchyma with limited assessment of the heart. Advances in multidetector CT technology with improved spatial and temporal resolution now permit accurate delineation of cardiac morphology. CT pulmonary angiography (CTPA) is widely utilised in the workup of patients with suspected pulmonary vascular disease and can identify both pulmonary and cardiac causes. As the initial presentation for CTPA is often precipitated by nonspecific, unexplained symptoms and therefore undertaken by a general radiologist, it is important that a systematic approach to the interpretation of these studies, including cardiac evaluation, is routinely adopted. This paper reviews the CT evaluation in pulmonary hypertension with a particular focus on the cardiac causes, their subclassification into congenital systemic to pulmonary shunts and secondary to left heart disease, and their imaging features. It emphasises the use of a systematic approach to interpretation of CTPA examinations both in patients with known PAH and those with previously unsuspected disease.
ISSN:0938-7994
1432-1084
DOI:10.1007/s00330-009-1460-0