Pulmonary Artery Hypertension

Short of Breath • Xray of the Week 2016 • Week #1

Differential diagnosis of dilated pulmonary artery (Fleischner sign):

Pulmonary arterial hypertension (PAH)

Pulmonary embolism

Post stenotic dilatation: pulmonary valve stenosis, pulmonary artery coarctation

Increased pulmonary blood flow: atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA)

Total anomalous pulmonary venous return (TAPVR)

pregnancy

High output cardiac failure: thyrotoxicosis, anaemia​

Marfan syndrome

Idiopathic dilatation of the pulmonary trunk

References:

Peña E, Dennie C, Veinot J et-al. Pulmonary hypertension: how the radiologist can help. Radiographics. 2012;32 (1): 9-32.

Henry Knipe, Frank Gaillard, et al. Radiopaedia: http://radiopaedia.org/articles/pulmonary-hypertension-1

Left image: Axial CT showing markedly enlarged pulmonary arteries.

Right image: Enlarged PA seen inferior to aortic arch.

Coronal CT showing large right main pulmonary artery.

Kevin M. Rice, MD is the president of Global Radiology CME

Dr. Rice serves as the Medical Director of the Radiology Department of Valley Presbyterian Hospital in Van Nuys, California. Dr. Rice has made several television and radio appearances and given numerous newspaper interviews as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice decided to launch Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field.

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