Pulmonary Hypertension Imaging

Author: Davinder Jassal; Chief Editor: Eugene C Lin, MD

Overview
Normal pulmonary circulation is a highflo!, lo!resistance circuit capa"le of accommodating
the entire right ventricular output at one fifth the pressure of the systemic circulation level# $he
thin!alled right ventricle functions primarily as a flo!generator pump and is particularly
sensitive to increases in its afterload# %ncreased pulmonary artery pressure and pulmonary
vascular resistance characteri&e pulmonary hypertension# 'ee the images "elo!#
(ulmonary hypertension# Chest radiograph in a patient !ith
secondary pulmonary hypertension reveals enlarged pulmonary arteries# $his patient !as found
to have an atrial septal defect#
(ulmonary hypertension# 'elective left pulmonary arteriogram reveals large central pulmonary
arteries and attenuation of the peripheral vessels, !ithout throm"i#
(ulmonary hypertension may "e divided into primary and secondary forms# (rimary pulmonary
hypertension )((*+ is a disease of un,no!n etiology, !hereas secondary pulmonary arterial
hypertension )'(A*+ is due to either intrinsic parenchymal disease of the lung or disease
e-trinsic to the lung#
Preferred examination
%n an individual !ith suspected pulmonary hypertension, ((* is the diagnosis of e-clusion#
*ence, a designated algorithm should "e used to e-clude secondary causes of pulmonary
hypertension# $he follo!ing are proposed investigations:
Autoanti"ody tests, *%. test, liver function tests
Electrocardiography
Chest radiography
(ulmonary function tests
Echocardiography
.entilationperfusion )./0+ scanning
Computed tomographic pulmonary angiography )C$(A+
(ulmonary angiography
Cardiac catheteri&ation
Magnetic resonance imaging )M1%+
As a "aseline, the first 2 tests are reasona"le for su"stantiating the presence of increased
pressures on the right side of the pulmonary vascular system# 3n the "asis of the results, a more
focused approach to esta"lish the etiology of the pulmonary hypertension may then involve tests
45# Most patients !ith secondary pulmonary hypertension do not re6uire rightheart
catheteri&ation "efore "eginning a trial !ith vasodilators# *o!ever, select patients, such as those
!ith collagen vascular disease, should undergo invasive investigations#
$he purposes of imaging studies in individuals !ith pulmonary hypertension are as follo!s:
Detecting pulmonary hypertension )echocardiography, cardiac catheteri&ation+
Differentiating the cause )echocardiography, ./0 scanning, C$(A, cardiac
catheteri&ation, pulmonary angiography, M1%+
Determining the severity )echocardiography, cardiac catheteri&ation+
Evaluating the status of the right ventricle )echocardiography, cardiac catheteri&ation,
M1%+
.arious imaging modalities, including chest radiography, C$, M1%, pulmonary function tests,
echocardiography, and angiography, have varia"le success in detecting the presence and severity
of pulmonary hypertension#
Electrocardiograms are useful for demonstrating signs of right ventricular hypertrophy and
strain# $hese signs include the follo!ing:
1ighta-is deviation
1/' ratio greater than 7 in lead .7
1ight atrial enlargement as indicated "y an increased (!ave amplitude in lead %%
1ight "undle "ranch "loc,
((* is diagnosed if no underlying etiology is found#
Radiography
Chest radiographs reveal a num"er of findings in pulmonary hypertension# )'ee the image
"elo!#+
(ulmonary hypertension# Chest radiograph in a patient !ith secondary pulmonary hypertension
reveals enlarged pulmonary arteries# $his patient !as found to have an atrial septal defect#
A dilated right heart due to right ventricular enlargement is seen as a decrease in the retrosternal
space on the lateral image# 1ight atrial enlargement may "e present if significant tricuspid
regurgitation is present# $his finding may "e recogni&ed "y the !idened right heart "order in the
frontal pro8ection and enlargement of the right atrial appendage in the lateral pro8ection, !hich is
seen as increased retrosternal opacity a"ove the e-pected location of the right ventricle#
Enlarged central pulmonary arteries that taper distally may "e found#
(eripheral vessel opacityoligemic lung fields may "e o"served# $his oligemia may "e
asymmetrical# $his is also a useful finding suggestive of chronic pulmonary em"olism )(E+#
An increase in the transverse diameter of the right interlo"ar artery is indicative of pulmonary
hypertension# $he upper limit of the transverse diameter of the right interlo"ar artery from its
lateral aspect to the intermediate "ronchus is 72 mm in !omen and 74 mm in men#
$he transverse diameter of the left interlo"ar artery is difficult to appreciate on the
posteroanterior )(A+ vie!# 9sing a lateral vie!, one can measure from the circular lucency of
the left upper lo"e "ronchus to the posterior margin of the vessel; the upper limit is 7: mm#
Evidence of right atrial dilatation and right ventricular dilatation may "e noted#
;erley < lines may "e present# $hese indicate the presence of pulmonary venous hypertension#
Causes of SPAH and their appearances
Atrial septal defect is characteri&ed "y cardiomegaly, enlargement of the right atrium and
ventricle, and enlargement of the central pulmonary arteries# Also present is rapid tapering, !ith
increased vascularity in the periphery of the lung#
Eisenmenger syndrome is characteri&ed "y peripheral oligemia, indicating the reversal of a left
toright shunt due to increased vascular resistance# $he peripheral vasculature is diminished, and
the cardiac morphology is consistent !ith cor pulmonale#
Computed Tomography
C$ scanning is a useful, noninvasive procedure for confirming the presence of pulmonary
hypertension#
C$(A is useful in delineating the anatomic detail of the pulmonary vasculature )see the image
"elo!+# Contrastenhanced images may sho! intraluminal a"normalities in the arteries and
veins, !hich are useful for confirming etiologies such as throm"oem"olic disease#
=7, >, ?, @, 2A
(ulmonary hypertension# C$ pulmonary angiogram in a @>year
old man !ho e-perienced severe chest pain after a long flight# %mage demonstrates clots in "oth
the right and left main pulmonary arteries#
'ometimes, if the em"oli are large, they may "e seen in the pulmonary arteries on a routine
contrastenhanced C$ scans#
C$(A, and often conventional pulmonary arteriography, is necessary for an ade6uate evaluation
of chronic (E# $he techni6ue of C$(A includes a rapid infusion at ?@ mL/s for a total of :B7>B
mL# Careful revie! of the images on a !or,station is the optimal method of detecting su"tle
em"oli# Evaluation of the lung !indo!s to detect a"normalities of perfusion )mosaic perfusion+
is necessary, as occlusions of ma8or pulmonary arterial "ranches may not "e present in a su"set
of patients !ith chronic pulmonary throm"oem"olism#
*ighresolution C$ )*1C$+ scanning of the chest has a role in the evaluation of pulmonary
hypertension in patients !ith suspected diffuse lung disease, eg, in patients !ith collagen
vascular disease#
;uriyama et al determined that a main pulmonary artery of >5 mm or larger, as sho!n on a C$
scan, has a sensitivity of 45C and a specificity of 7BBC for predicting pulmonary hypertension#
$he !idest portion of the main pulmonary artery !ithin ? cm of the "ifurcation !as used to
determine the value# %n addition, $an et al demonstrated that individuals !ith intrinsic lung
disease can "e identified as having pulmonary hypertension if the main pulmonary artery is
greater than >5 mm#
$he upper limit of normal for the diameter of the pulmonary artery is >:#4 mm# A value greater
than >:#4 mm suggests increased pressures in the pulmonary system# )'ee the image "elo!#+
(ulmonary hypertension# 'piral C$ scan in a patient !ith pulmonary hypertension reveals
enlarged pulmonary arteries and an a"sence of throm"osis#
egree of confidence
C$(A is the "est method for demonstrating em"oli# *1C$ is useful for demonstrating lung
disease, !hich may account for secondary pulmonary hypertension#
!agnetic Resonance Imaging
M1% !ith contrast enhancement allo!s one to distinguish "et!een the pulmonary vasculature
and mediastinal adenopathy#
=>, 4, 2, DA
M1% has capa"ilities similar to those of echocardiography in the diagnosis and treatment of
patients !ith pulmonary hypertension# M1% is useful for measuring the mass, volume, and
overall function of the right ventricle# M1% is also useful for detecting shunt lesions contri"uting
to pulmonary hypertension# Acute and chronic pulmonary throm"oem"olic disease can "e
confirmed "y using this imaging modality#
egree of confidence
$he disadvantages !ith M1% include limitations in individuals !ith cardiac pacema,ers and
defi"rillators, its limited availa"ility and cost, and difficulty in assessing estimate (A pressures
!ith M1%#
"ltrasonography
%n evaluating pulmonary hypertension, echocardiography can "e used to identify secondary
causes, such as congenital, valvular, and myocardial disease# %n addition, one may estimate
pulmonary artery systolic pressure !ith this method#
=:A
'pecifically, the Eorld *ealth
3rgani&ation )E*3+ has defined pulmonary hypertension as a systolic pressure greater than ?B
mm *g; this corresponds to a tricuspid regurgitant velocity of ?#B m/s on echocardiography#
$he follo!ing findings for pulmonary hypertension are confirmed on echocardiography: )7+ right
atrial and ventricular enlargement, and )>+ parado-ical movement of the interventricular septum,
and tricuspid regurgitation# )%f right ventricular enddiastolic pressures are greater than >B mm
hg, the ris, of sudden death is relatively high#+
Doppler echocardiography is the most relia"le noninvasive method for estimating pulmonary
artery pressure# $ricuspid regurgitation is often present in pulmonary hypertension# %t is detected
in more than 5BC of patients !ith severe pulmonary hypertension, !ith a correlation of more
than 52C !hen the pressure is measured "y means of catheteri&ation#
#uclear Imaging
1adioisotope perfusion lung scanning is performed !ith intravenous in8ection of particles of
al"umin la"eled !ith technetium55m# As these particles perfuse the lung, the lungs are imaged
"y using a gamma camera to o"tain anterior, posterior, lateral, and o"li6ue vie!s# 3ne !ould
e-pect a normal distri"ution of these particles, !hich produce > "lac,ened lungshaped shado!s#
%n ((*, the ./0 scan is usually normal#
%n secondary pulmonary hypertension due to chronic throm"oem"olic disease, em"oli are
responsi"le for "loc,ing the "ranches of the pulmonary artery# $he lung tissue peripheral to the
"loc, is not perfused; this "loc, results in a defect on the scan# Ehen findings in the perfusion
scan are a"normal, a ventilation scan is o"tained ne-t "y using inhalational radioactive -enon
7??# A num"er of lung diseases, including pneumonia and C3(D, can cause alterations in the
ventilation component, !hereas uncomplicated (E does not# $hus, a patient !ith a high
li,elihood of (E has an a"normal perfusion scan !ith a normal ventilation component# )'ee the
image "elo!#+
(ulmonary hypertension# .entilationperfusion )./0+ scans sho! "ilateral mismatched
segmental and su"segmental defects due to chronic throm"oem"olic disease, !hich has lead to
secondary pulmonary arterial hypertension#
Angiography
1ight heart catheteri&ation may "e re6uired# (ulmonary angiography is the most accurate
modality for evaluating the anatomy and pathophysiology of pulmonary hypertension# <er"erich
and *irsch o"tained the first pulmonary angiogram in 75>?, and 1o"" and 'tein"erg later
optimi&ed the techni6ue in 75?7# $his e-amination is the criterion standard for the diagnosis of
pulmonary hypertension# )'ee the images "elo!#+
(ulmonary hypertension# 'elective right pulmonary arteriogram demonstrates large central
pulmonary arteries and attenuation of the peripheral vessels, !ithout any definite demonstra"le
throm"i#

(ulmonary hypertension# 'elective left pulmonary arteriogram reveals large central pulmonary
arteries and attenuation of the peripheral vessels, !ithout throm"i#
(ulmonary angiography should "e performed !hen the results of ./0 scanning cannot e-clude
chronic throm"oem"olic disease as an etiology for the elevated pulmonary pressures# $he
angiogram reveals large central pulmonary arteries !ith mar,ed peripheral tapering#
$he disadvantage of pulmonary angiography is that it is an invasive procedure as one cannulates
the right side of the heart and the pulmonary artery# Complications include )7+ transient rhythm
distur"ances that respond to the removal of the catheter, )>+ cardiac perforation leading to
pericardial tamponade, and )?+ nephroto-icity# %n patients !ith an elevated creatinine level )7#2
F normal+, the use of highosmolar contrast material poses a ris, of nephroto-icity# $his pro"lem
is less commonly seen !ith the selective use of small amounts of lo!osmolar nonionic contrast
material# $he fre6uency of complications !ith pulmonary angiography is limited to G 2C of
cases e-amined#
Hipertensi Paru Pencitraan
H (enulis : Davinder Jassal , (emimpin 1eda,si : Eugene C Lin , MD
I$htisar
'ir,ulasi paruparu yang normal adalah aliran tinggi , resistansi rendah sir,uit yang mampu
menampung seluruh ,eluaran ventri,el ,anan pada seperlima te,anan ting,at sir,ulasi sistemi, #
$he "erdinding tipis fungsi ventri,el ,anan terutama se"agai pompa aliran generator dan sangat
sensitif terhadap pening,atan afterload nya # (ening,atan te,anan arteri pulmonalis dan resistensi
vas,uler paru ciri hipertensi pulmonal # Lihat gam"ar di "a!ah #
*ipertensi pulmonal # 1ontgen dada pada pasien dengan hipertensi pulmonal se,under
mengung,ap,an arteri paru mem"esar # (asien ini ditemu,an memili,i cacat septum atrium #

*ipertensi pulmonal # 'ele,tif arteriogram paru ,iri mengung,ap,an "esar arteri paru pusat dan
redaman dari pem"uluh perifer , tanpa trom"us #
*ipertensi pulmonal dapat di"agi men8adi "entu, primer dan se,under # (ulmonary hypertension
primer ) ((* + adalah penya,it etiologi tida, di,etahui , sedang,an se,under hipertensi arteri
paru ) '(A* + adalah ,arena "ai, penya,it paren,im intrinsi, dari paruparu atau penya,it
e,strinsi, ,e paruparu #
pemeri,saan disu,ai
Dalam individu yang diduga hipertensi paru, ((* adalah diagnosis e,s,lusi # 3leh ,arena itu ,
algoritma yang ditun8u, harus diguna,an untu, menying,ir,an penye"a" se,under hipertensi
pulmonal # <eri,ut ini adalah investigasi yang diusul,an :
H $es Autoanti"odi , tes *%. , tes fungsi hati
H Ele,tro,ardiografi
H 1adiografi dada
H $es fungsi paru
H Echocardiography
H .entilasi perfusi ) . / 0 + scanning
H Computed tomografi paru angiografi ) C$(A +
H Angiografi paru
H ;ateterisasi 8antung
H Magnetic 1esonance %maging ) M1% +
'e"agai dasar, pertama 2 tes !a8ar untu, su"stantiating adanya te,anan mening,at di sisi ,anan
dari sistem pem"uluh darah paru # <erdasar,an hasil , pende,atan yang le"ih terfo,us untu,
mem"angun etiologi hipertensi paru dapat ,emudian meli"at,an tes 45 # ;e"anya,an pasien
dengan hipertensi pulmonal se,under tida, memerlu,an ,ateterisasi 8antung ,anan se"elum
memulai sidang dengan vasodilator # Namun, pasien pilih , seperti orang dengan penya,it
vas,ular ,olagen , harus men8alani investigasi invasif #
$u8uan dari studi pencitraan pada individu dengan hipertensi paru adalah se"agai "eri,ut :
H Mendete,si hipertensi pulmonal ) e,o,ardiografi , ,ateterisasi 8antung +
H Mem"eda,an penye"a" ) echocardiography , . / 0 scanning , C$(A , ,ateterisasi 8antung ,
angiografi paru , M1% +
H Menentu,an ,eparahan ) e,o,ardiografi , ,ateterisasi 8antung +
H Mengevaluasi status ventri,el ,anan ) e,o,ardiografi , ,ateterisasi 8antung , M1% +
<er"agai modalitas pencitraan , termasu, radiografi dada , C$ , M1% , tes fungsi paru ,
e,o,ardiografi , dan angiografi , su,ses varia"el dalam mendete,si ,e"eradaan dan ting,at
,eparahan hipertensi pulmonal #
Electrocardiograms "erguna untu, menun8u,,an tandatanda hipertrofi ventri,el ,anan dan
,etegangan # $andatanda ini meliputi :
H deviasi ,anan sum"u
H 1 / ' ratio le"ih "esar dari 7 dalam memimpin .7
H pem"esaran atrium ,anan seperti yang ditun8u,,an oleh pening,atan amplitudo gelom"ang (
dalam memimpin %%
H *a, "lo, ca"ang "er,as
((* didiagnosis 8i,a tida, ada etiologi yang mendasari ditemu,an #
radiografi
1adiografi dada mengung,ap,an se8umlah temuan pada hipertensi pulmonal # ) Lihat gam"ar di
"a!ah # +

*ipertensi pulmonal # 1ontgen dada pada pasien dengan hipertensi pulmonal se,under
mengung,ap,an arteri paru mem"esar # (asien ini ditemu,an memili,i cacat septum atrium #
'e"uah 8antung ,anan mele"ar a,i"at pem"esaran ventri,el ,anan dipandang se"agai penurunan
dalam ruang retrosternal pada gam"ar lateral# (em"esaran atrium ,anan mung,in hadir 8i,a
regurgitasi tri,uspid yang signifi,an hadir # $emuan ini dapat dia,ui oleh mele"ar per"atasan
8antung ,anan dalam proye,si frontal dan pem"esaran atrium em"el tepat di proye,si lateral,
yang dipandang se"agai pening,atan opacity retrosternal di atas lo,asi yang diharap,an dari
ventri,el ,anan #
(em"esaran arteri paru sentral yang lancip distal dapat ditemu,an #
;apal lapang paru opacity oligemic perifer dapat diamati # 3ligemia ini mung,in asimetris # %ni
8uga merupa,an temuan yang "erguna sugestif em"oli paru ,ronis ) (E + #
(ening,atan diameter melintang dari interlo"ar arteri yang tepat merupa,an indi,asi hipertensi
pulmonal # <atas atas dari diameter transversal ha, interlo"ar arteri dari aspe, lateral ,e
menengah "ron,us adalah 72 mm pada !anita dan 74 mm pada pria #
Melintang diameter arteri interlo"ar ,iri sulit untu, menghargai pada posteroanterior ) (A +
tampilan # Mengguna,an tampilan lateral , seseorang dapat mengu,ur dari lucency meling,ar
"ron,us lo"us atas ,iri ,e sisi "ela,ang ,apal; "atas atas adalah 7: mm #
<u,ti dilatasi atrium ,anan dan dilatasi ventri,el ,anan dapat dicatat #
;erley garis < dapat hadir # %ni menun8u,,an adanya hipertensi vena pulmonal #
(enye"a" '(A* dan penampilan mere,a
Defe, septum atrium ditandai dengan ,ardiomegali , pem"esaran atrium ,anan dan ventri,el ,
dan pem"esaran arteri paru pusat# Juga hadir adalah cepat lon8ong , dengan pening,atan
vas,ularisasi di pinggiran paruparu #
'indrom Eisenmenger ditandai dengan oligemia perifer , menun8u,,an pem"ali,an shunt ,iri
,e,anan ,arena mening,atnya resistensi pem"uluh darah # $he perifer pem"uluh darah
"er,urang , dan morfologi 8antung ,onsisten dengan cor pulmonale #
computed $omography
C$ scan adalah "erguna , prosedur noninvasif untu, meng,onfirmasi ,ehadiran hipertensi
pulmonal #
C$(A "erguna dalam menggam"ar,an detail anatomi pem"uluh darah paru ) lihat gam"ar di
"a!ah + # Iam"ar ,ontras diting,at,an mung,in menun8u,,an ,elainan intraluminal di arteri dan
vena , yang "erguna untu, meng,onfirmasi,an etiologi seperti penya,it trom"oem"oli = 7 , > , ? ,
@ , 2 A #
*ipertensi pulmonal # C$ angiogram paru pada seorang pria @> tahun yang mengalami nyeri
dada yang parah setelah pener"angan yang pan8ang # Iam"ar menun8u,,an gumpalan di ,edua
arteri pulmonalis utama ,anan dan ,iri #
$er,adang, 8i,a em"oli yang "esar, mere,a dapat dilihat di arteri paru pada rutin ,ontras
diting,at,an C$ scan #
C$(A , dan sering arteriografi paru ,onvensional , diperlu,an untu, evaluasi cu,up ,ronis (E #
$e,ni, C$(A termasu, infus cepat pada mL / s ?@ untu, total :B7>B mL # 'e,sama terhadap
gam"ar pada !or,station adalah metode yang optimal untu, mendete,si em"oli halus# Evaluasi
8endela paruparu untu, mendete,si ,elainan perfusi ) mosai, perfusi + diperlu,an, ,arena o,lusi
arteri ca"ang utama paru mung,in tida, hadir dalam su"set dari pasien dengan trom"oem"oli
paru ,roni, #
C$ resolusi tinggi ) *1C$ + scanning dada memili,i peran dalam evaluasi hipertensi paru pada
pasien dengan dugaan penya,it paruparu difus , misalnya pada pasien dengan penya,it vas,ular
,olagen #
;uriyama et al ditentu,an "ah!a arteri pulmonalis utama >5 mm atau le"ih "esar , seperti yang
ditun8u,,an pada C$ scan , memili,i sensitivitas 45 C dan spesifisitas 7BB C untu,
mempredi,si hipertensi pulmonal # <agian terluas dari arteri pulmonalis utama dalam ? cm dari
"ifur,asi ini diguna,an untu, menentu,an nilai# 'elain itu, $an d,, menun8u,,an "ah!a
individu dengan penya,it paruparu intrinsi, dapat diidentifi,asi se"agai memili,i hipertensi
paru 8i,a arteri pulmonalis utama le"ih "esar dari >5 mm #
<atas atas normal untu, diameter arteri pulmonalis adalah >:,4 mm # 'e"uah nilai yang le"ih
"esar dari >:,4 mm menun8u,,an pening,atan te,anan dalam sistem paru # ) Lihat gam"ar di
"a!ah # +
*ipertensi pulmonal # 'piral C$ scan pada pasien dengan hipertensi pulmonal mengung,ap,an
arteri paru mem"esar dan tida, adanya trom"osis #
$ing,at ,epercayaan
C$(A adalah metode ter"ai, untu, menun8u,,an em"oli # *1C$ "erguna untu, menun8u,,an
penya,it paruparu , yang dapat men8elas,an hipertensi pulmonal se,under #
Magnetic 1esonance %maging
M1% dengan pening,atan ,ontras memung,in,an seseorang untu, mem"eda,an antara
pem"uluh darah paru dan adenopati mediastinum # = > , 4 , 2 , D A
M1% memili,i ,emampuan yang sama dengan e,o,ardiografi dalam diagnosis dan pengo"atan
pasien dengan hipertensi pulmonal # M1% "erguna untu, mengu,ur massa , volume, dan fungsi
,eseluruhan dari ventri,el ,anan # M1% 8uga "erguna untu, mendete,si lesi shunt "er,ontri"usi
terhadap hipertensi paru # (enya,it trom"oem"oli paru a,ut dan ,ronis dapat di,onfirmasi,an
dengan mengguna,an pencitraan ini modalitas #
$ing,at ,epercayaan
;elemahan dengan M1% termasu, ,eter"atasan pada individu dengan alat pacu 8antung dan
defi"rillator , ter"atasnya ,etersediaan dan "iaya , dan ,esulitan dalam menilai te,anan (A
per,iraan dengan M1% #
ultrasonografi
Dalam mengevaluasi hipertensi pulmonal , echocardiography dapat diguna,an untu,
mengidentifi,asi penye"a" se,under , seperti penya,it "a!aan , ,atup , dan mio,ard # 'elain itu,
seseorang dapat memper,ira,an te,anan sistoli, arteri pulmonalis dengan metode ini = : A 'ecara
,husus , 3rganisasi ;esehatan Dunia ) E*3 + telah mendefinisi,an hipertensi pulmonal se"agai
te,anan sistoli, le"ih dari ?B mm *g , # %ni sesuai dengan ,ecepatan regurgitasi tri,uspid dari ?,B
m / s pada echocardiography #
$emuan "eri,ut untu, hipertensi paru di,onfirmasi pada echocardiography : ) 7 + pem"esaran
atrium ,anan dan ventri,el , dan )> + gera,an parado,sal dari septum interventri,ular , dan
regurgitasi tri,uspid # ) Ji,a ventri,el te,anan a,hir diastoli, ,anan le"ih "esar dari >B mm hg ,
risi,o ,ematian mendada, relatif tinggi # +
Doppler echocardiography adalah metode noninvasif yang paling dapat diandal,an untu,
memper,ira,an te,anan arteri pulmonalis # $ri,uspid regurgitasi sering hadir dalam hipertensi
paru # *al ini terdete,si di le"ih dari 5B C pasien dengan hipertensi pulmonal "erat , dengan
,orelasi le"ih dari 52 C ,eti,a te,anan diu,ur dengan cara ,ateterisasi #
nu,lir (encitraan
1adioisotop perfusi paru dila,u,an dengan in8e,si intravena parti,el al"umin di"eri la"el dengan
te,nesium55m # 'e"agai parti,elparti,el ini menyem"ur paruparu , paruparu yang dicitra,an
dengan mengguna,an ,amera gamma untu, mendapat,an anterior , posterior , lateral, dan
miring dilihat # 'alah satu harap,an distri"usi normal parti,elparti,el ini , yang memprodu,si >
"ayangan "er"entu, paru menghitam #
Dalam ((* , . / 0 scan "iasanya normal #
Dalam hipertensi pulmonal se,under a,i"at penya,it trom"oem"oli ,ronis, em"oli "ertanggung
8a!a" untu, mem"lo,ir ca"angca"ang arteri pulmonalis # Jaringan paruparu perifer ,e "lo,
tida, perfusi , "lo, ini menghasil,an cacat di scan # ;eti,a temuan dalam scan perfusi a"normal ,
scan ventilasi diperoleh "eri,utnya dengan mengguna,an inhalasi radioa,tif -enon 7?? #
'e8umlah penya,it paruparu , termasu, pneumonia dan ((3; , dapat menye"a",an peru"ahan
dalam ,omponen ventilasi , sedang,an (E rumit tida, # Dengan demi,ian , pasien dengan
,emung,inan tinggi (E memili,i scan perfusi a"normal dengan ,omponen ventilasi normal#
) Lihat gam"ar di "a!ah # +

*ipertensi pulmonal # .entilasi perfusi ) . / 0 + scan menun8u,,an cacat segmental dan
su"segmental "ilateral serasi ,arena penya,it trom"oem"oli ,ronis , yang telah menye"a",an
se,under hipertensi arteri paru #
angiografi
;ateterisasi 8antung ,anan mung,in diperlu,an # Angiografi paru adalah modalitas yang paling
a,urat untu, mengevaluasi anatomi dan patofisiologi hipertensi pulmonal # <er"erich dan *irsch
memperoleh angiogram paru pertama pada tahun 75>? , dan 1o"" dan 'tein"erg ,emudian
dioptimal,an te,ni, pada tahun 75?7 # (emeri,saan ini merupa,an standar ,riteria untu,
diagnosis hipertensi pulmonal # ) Lihat gam"ar di "a!ah # +

*ipertensi pulmonal # 'ele,tif arteriogram paru ,anan menun8u,,an "esar arteri paru pusat dan
redaman dari pem"uluh perifer , tanpa trom"i di"u,ti,an pasti#

*ipertensi pulmonal # 'ele,tif arteriogram paru ,iri mengung,ap,an "esar arteri paru pusat dan
redaman dari pem"uluh perifer , tanpa trom"us #
Angiografi paru harus dila,u,an ,eti,a hasil . / 0 scanning tida, "isa mengecuali,an penya,it
trom"oem"oli ,ronis se"agai penye"a" untu, te,anan paru ditinggi,an # Angiogram
menun8u,,an "esar arteri paru pusat dengan ditandai perifer meruncing #
;erugian dari angiografi paru adalah "ah!a hal itu merupa,an prosedur invasif se"agai salah
satu cannulates sisi ,anan 8antung dan arteri pulmonalis # ;ompli,asi termasu, ) 7 + gangguan
irama transien yang merespon penghapusan ,ateter , ) > + 8antung yang mengarah ,e perforasi
tamponade peri,ardial , dan ) ? + nefroto,sisitas # (ada pasien dengan ,adar ,reatinin tinggi ) 7,2
F normal+ , penggunaan "ahan ,ontras tinggi osmolar menim"ul,an risi,o nefroto,sisitas #
Masalah ini ,urang sering terlihat dengan penggunaan sele,tif se8umlah ,ecil "ahan ,ontras
nonioni, rendah osmolar # Jre,uensi ,ompli,asi dengan angiografi paru ter"atas pada G 2 C
,asus yang diperi,sa #