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Pulmonary Hypertension

CT Chest Report

08/12/2009

Question:

I am a 44 yr old female with a hx of mitochondrial myopathy and resp.muscle weakness. I recently had a ct chest and muga scan. here is the official ct report: findings: No mediastinal,hilar or axillary adenopathy. left infrahilar calcified lymph node is seen. No pericardial or pleural effusion. Main pulmonary artery measures 3.7 cm. Lungs are hyperinflated. Mild emphysematous changes are seen. No pneumothorax. Mild bronchial wall thickening is seen. There is a cluster of nodular opacities seen in the medial left perihilar/left upper lobe region suggestive of mucus plugging. Developing pneumonitis cannot be excluded. Subsegmental atelectasis along the left major fissure. Calcified lymph node is seen . Impression: 1. hyperinflation with mild emphysematous changes and bronchial wall thickening. Cluster of left perihilar nodular opacities is suggestive of bronchial mucus plugging with possible developing pneumonitis. Recommend follow up ct chest in 3 mos to document resolution.( i assume he means the possible pneumonitis) 2. Pulmonary Arterial Hypertension here is my muga report: 1. Normal contractile function with no focal wall motion abnormalities and a calculated EF of 76%. This is increased from 59% on the previous study 07/09/2008 2. Normal peak filling rate of 3.25 at a heart rate of 82 bpm consistent with normal left ventricular compliance. This is increased from 1.9 from last year`s study. 3. Normal right ventricular systolic function with calculated EF of 75%, however visually appears to be around 60%. This is increased from 50 % from the 7/9/08 study. Is the pulmonary artery measurement high? In light of the muga scan- would a rt heart cath be indicated ? What kind of followup to this should I expect? Thanks so much.

Answer:

The radiologist is concerned about pulmonary hypertension based on the size of the pulmonary artery. This is not a very good way to diagnose pulmonary hypertension. There is concern for pulmonary hypertension if the size of the pulmonary artery is greater than 3.5cm, but there is a lot of variability. Your MUGA scan looks good and does not suggest pulmonary hypertension . I would suggest you discuss it with your doctor if further evaluation is needed.

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Response by:

Namita   Sood, MD, FCCP Namita Sood, MD, FCCP
Associate Professor of Pulmonary, Critical Care & Sleep
College of Medicine
The Ohio State University