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E1845. Pulmonary Hypertension: Pearls in Thoracic Imaging
Authors
  1. Juliana Sitta; University of Mississippi Medical Center
  2. Candace Howard; University of Mississippi Medical Center
Background
Currently, the gold standard diagnostic method for pulmonary hypertension (PH) is obtained by directly measuring pulmonary arterial pressures by right heart catheterization. However, although diagnostic, right heart catheterization cannot provide further information about the etiology and possible treatable causes of PH. Thus, additional investigational tools, including various imaging methods, are needed to aid in the investigation and categorization of PH. The World Health Organization (WHO) etiology categorization of PH comprises five categories, much of which can be depicted on chest imaging. With advancing imaging techniques providing more information without the need of invasive procedures, a thorough understanding of the physiopathology, risk assessment, and the hallmarks of PH on chest computed tomography (CT) and magnetic resonance imaging (MRI) is of utmost importance to guide clinical management.

Educational Goals / Teaching Points
Review of the pathophysiology and the WHO categorization of PH. Describe imaging patterns and PH categorization with CT and MRI. Analyze common and uncommon etiologies with a case-based review

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This presentation aims to discuss imaging findings in the diagnosis and categorization of PH from chest CT and MRI. We will explore the spectrum of possible findings within the pulmonary parenchyma, airways, mediastinum, heart, and vessels to help narrow down the differential diagnosis. We provide a review of the diagnostic criteria and key imaging findings, correlated with physiopathology and the current categorization. We also include a discussion of pros and cons of the currently available diagnostic tools and an update of the most recent imaging technical advancements. Additionally, a case-based review exemplifies common and uncommon etiologies leading to PH.

Conclusion
Pulmonary hypertension may be diagnosed on chest imaging following expected indirect findings. Imaging methods are continuously advancing to provide biomarkers that allow non-invasive diagnostic techniques. However, the role of the radiologist goes beyond solely diagnosis in PH. Imaging permits assessment of a wide range of differential diagnoses, categorization, stratification of risk, guidance for further management and follow-up.