Medical image of the week: refractory dyspnea

• Main Authors: Malo J, Reyes N, Rischard F
• Format: Article
• Language: English
• Published: Arizona Thoracic Society 2012-12-01
• Series: Southwest Journal of Pulmonary and Critical Care
• Subjects: pulmonary artery hypertension; pulmonary embolus; thromboembolic pulmonary artery hypertension; PAH; dyspnea
• Online Access: http://www.swjpcc.com/imaging/2012/12/26/medical-image-of-the-week-refractory-dyspnea.html

A 61 year old man with an extensive smoking history and emphysema was referred for evaluation of dyspnea refractory to standard therapy. He was diagnosed with a pulmonary embolism 5 months prior to presentation and has been on warfarin since that time. Review of the patient’s CT scan performed prior to the visit demonstrated dilated main; right; and left pulmonary arteries (Figure 1). Also visualized was an eccentrically located thrombus with areas of calcification and central recanalization. Echocardiography confirmed the presence of elevated pulmonary pressures consistent with a diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). Medical therapy and a referral for pulmonary artery endarterectomy are being considered.