Medical Image of the Week: Refractory Dyspnea

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.

Figure 1. Chest CT scan showing dilated main, right, and left pulmonary arteries.  Also visualized was an eccentrically located thrombus (arrows) with areas of calcification and central recanalization

Josh Malo, MD; Nathaniel Reyes, MD; Linda Snyder MD; and Franz Rischard, DO

Division of Pulmonary, Critical Care, Allergy and Sleep Medicine

Arizona Respiratory Center

University of Arizona

Tucson, Arizona

Reference as: Malo J, Reyes N, Rischard F. Medical image of the week: refractory dyspnea. Southwest J Pulm Crit Care 2012;5:308. PDF