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Findings on Submillimeter MDCT Are Predictive of Operability in Chronic Thromboembolic Pulmonary Hypertension

Jean-François Paul1, Antoine Khallil1, Anne Sigal-Cinqualbre1, François Leroy-Ladurie2, Jacques Cerrina2, Elie Fadel2 and Philippe Dartevelle2

1 Department of Radiology, Hôpital Marie Lannelongue, 133 ave. de la Résistance, Le Plessis-Robinson, France 92350.
2 Department of Thoracic Surgery, Hôpital Marie Lannelongue, Le Plessis-Robinson, France 92350.


Figure 1
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  		Fig. 1A —60-year-old man with severe dyspnea (New York Heart Association class 4). Contrast-enhanced thin-slab maximum-intensity-projection CT image oriented in long axis of left pulmonary artery shows obstructive form of chronic thromboembolic pulmonary hypertension. Presence of proximal endarterectomy plane is evident in left pulmonary artery, which is completely obstructed (arrows) in proximal aspect. Clot thickness was 22 mm.

 

Figure 2
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  		Fig. 1B —60-year-old man with severe dyspnea (New York Heart Association class 4). Photograph of surgical specimen removed from left pulmonary artery bed shows good correspondence with CT findings.

 

Figure 3
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  		Fig. 2 —76-year-old man with dyspnea (New York Heart Association class 3) and chronic thromboembolic pulmonary hypertension. Contrast-enhanced thin-slab maximum-intensity-projection CT image oriented in long axis of right pulmonary artery shows diffuse thickening along pulmonary arterial wall. Proximal thickening (endarterectomy plane) is clearly visible downstream from origin of right interlobar artery. Starting point of endarterectomy plane is origin of right interlobar artery (arrow), which is surgically accessible. Mural thickening varies from 8 mm (interlobar level) to 2.5 mm (lobar level). Endovascular thrombotic material is visible as dark gray mural thickening (arrowheads) responsible for multiple segmental obstructions (asterisk). Excellent endarterectomy plane was found at surgery.

 

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