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Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 88-89

Spot the abnormality

Department of Respiratory Medicine, A J Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India

Date of Submission26-Sep-2021
Date of Acceptance12-Oct-2021
Date of Web Publication21-Jan-2022

Correspondence Address:
M Vishnu Sharma
Department of Respiratory Medicine, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/japt.japt_39_21

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How to cite this article:
Sharma M V, Walikar BA. Spot the abnormality. J Assoc Pulmonologist Tamilnadu 2021;4:88-9

How to cite this URL:
Sharma M V, Walikar BA. Spot the abnormality. J Assoc Pulmonologist Tamilnadu [serial online] 2021 [cited 2022 May 16];4:88-9. Available from: http://www.japt.com/text.asp?2021/4/2/88/336169

  Question Top

What is the abnormality in the computed tomography [CT] pulmonary angiogram image [Figure 1]?
Figure 1: Computed tomography pulmonary angiogram axial image

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  Answer Top

In the CT pulmonary angiogram image, diameter of the main pulmonary artery (PA) is more than that of ascending aorta which is suggestive of pulmonary arterial hypertension (PAH). Main PA diameter is measured at its bifurcation in axial CT image, perpendicular to its long axis. Diameter more than 29 mm is suggestive of PAH.[1] This has 97% positive predictive value, 89% specificity and 87% sensitivity. In this case, it was 46.7 mm [Figure 2].
Figure 2: Computed tomography pulmonary angiogram axial image showing measurement of main pulmonary artery diameter

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When the diameter of main PA is larger than that of the adjacent ascending thoracic aorta in axial view in thoracic CT scan, it is suggestive of moderate or severe PAH.[2] In mild PAH main PA diameter may be normal.

For accurate assessment of pulmonary hypertension (PH), PA pressure and pulmonary arterial wedge pressure should be measured by right heart catheterization. This invasive method requires specialist centers with experts. Hence most often PH is measured by echocardiography. PH is measured indirectly by echocardiography by measuring maximal tricuspid regurgitation velocity with continuous-wave Doppler.[3] This can be obtained only in the presence of a measurable TR signal. Tricuspid regurgitation is found in approximately 80% of patients with systolic pulmonary pressure above >35 mmHg. It should be remembered that a small subset of patients with severe PH may have little or no tricuspid regurgitation.[3] Hence, it is important to compare the diameter of main PA to that of ascending aorta in thoracic CT axial image.

The ratio of the diameter of PA to that of the aorta more than 1 is a reliable indicator of PH.[2] In patients with underlying lung disease increase in diameter of PA is associated with increased PAH, more severe/extensive/advanced lung disease, frequent exacerbations and poor long-term prognosis.[4]

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Conflicts of interest

There are no conflicts of interest.

  References Top

Lewis G, Hoey ET, Reynolds JH, Ganeshan A, Ment J. Multi-detector CT assessment in pulmonary hypertension: Techniques, systematic approach to interpretation and key findings. Quant Imaging Med Surg 2015;5:423-32.  Back to cited text no. 1
Frazier AA, Galvin JR, Franks TJ, Rosado-De-Christenson ML. From the archives of the AFIP: Pulmonary vasculature: Hypertension and infarction. Radiographics 2000;20:491-524.  Back to cited text no. 2
Shah RK. Echocardiographic evaluation of pulmonary hypertension. J Indian Acad Echocardiogr Cardiovasc Imaging 2018;2:95-105.  Back to cited text no. 3
  [Full text]  
Tan RT, Kuzo R, Goodman LR, Siegel R, Haasler GB, Presberg KW. Utility of CT scan evaluation for predicting pulmonary hypertension in patients with parenchymal lung disease. Medical College of Wisconsin Lung Transplant Group. Chest 1998;113:1250-6.  Back to cited text no. 4


  [Figure 1], [Figure 2]


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