Cardiology>>>>>Pulmonary Hypertension And Pericardium
Question 5#

You have been contacted by the infectious diseases team about a man with HIV who has become progressively more breathless over a series of months. He has had a CT pulmonary angiogram which has excluded clots. You discuss the scan with the radiologist.

What else would you like to know about the CT?

A) The size of the right ventricle—if it is normal, this excludes pulmonary hypertension as a cause for his symptoms
B) The position of the interventricular septum as this indicates the balance of pressures between right and left atrium
C) Whether there is reflux of contrast into the superior vena cava since this suggests elevated right atrial pressures
D) The size of the pulmonary arteries—if these are dilated, it suggests that pulmonary hypertension might be present
E) A pericardial effusion is not in keeping with pulmonary hypertension and should trigger a search for malignancy

Correct Answer is D

Comment:

CT can provide important information in addition to the presence or absence of pulmonary emboli. An enlarged right ventricle (though it can be normally sized), right atrium, and pulmonary arteries are all features of PH. Contrast reflux into the inferior vena cava implies tricuspid regurgitation and increased right atrial pressure. The latter is also indicated when the right atrium is dilated. The position of the interventricular septum and the interatrial septum reflects the balance of pressures between the ventricles and atria, respectively.