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Predictors of Patient Response to Pulmonary Thromboendarterectomy

Colleen J. Bergin1,2, Claude Sirlin1, Reena Deutsch3, Peter Fedullo4, John Hauschildt1, Tung Huynh1, William Auger4 and Michele Brown1

1 Department of Radiology, University of California, 200 W. Arbor Dr., San Diego, CA 92103.
2 Present address: Department of Anatomy with Radiology, University of Auckland, Park Rd., Auckland, New Zealand.
3 General Clinical Research Center, University of California, San Diego, CA 92103.
4 Department of Medicine, University of California, San Diego, CA 92103.



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  		Fig. 1. —63-year-old man with chronic thromboembolic pulmonary hypertension. CT angiogram shows thromboembolic material lining posterior wall of right pulmonary artery. Note thickened, irregular, calcified intimal surface of pulmonary artery.

 


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  		Fig. 2A. —57-year-old woman with chronic thromboembolic pulmonary hypertension. CT angiogram at mediastinal window shows weblike narrowing (arrow) in lingular artery.

 


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  		Fig. 2B. —57-year-old woman with chronic thromboembolic pulmonary hypertension. CT angiogram at lung window shows reduced caliber of lingular branch to superior segment (straight arrow) and normal-appearing branch to inferior segment (curved arrow) of lingula. Right upper lobe anterior segmental artery is also diminutive (arrowhead).

 


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  		Fig. 3A. —57-year-old woman with chronic thromboembolic pulmonary hypertension. CT angiogram at lung window shows mosaic perfusion in both upper lobes with enlarged arteries in apicoposterior segment on left and in anterior segment on right (arrows).

 


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  		Fig. 3B. —57-year-old woman with chronic thromboembolic pulmonary hypertension. CT angiogram at mediastinal window shows normal contour and contrast enhancement within arteries in apicoposterior segment on left and in anterior segment of right upper lobe (arrows).

 


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  		Fig. 3C. —57-year-old woman with chronic thromboembolic pulmonary hypertension. CT angiogram at mediastinal window shows normal-sized pulmonary vessels. Notice smaller size of segmental vessels compared with B.

 


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  		Fig. 4. —Bar graph shows relationship between postoperative pulmonary vascular resistance and median number of segments revealed on CT angiography to have abnormal perfusion but normal segmental arteries. Figures shown are average scores for observers 1 and 2. Note that postoperative pulmonary vascular resistance remained abnormal for patients whose preoperative CT angiograms showed more than one segment in which perfusion was abnormal with normal segmental artery.

 

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