IS Case 325: Pulmonary hypertension

Gunvir Gill, MD

Imaging Sciences URMC 2009
Publication Date: 2009-09-14


Patient is a 53-year-old male with known history of pulmonary hypertension who presented for preoperative chest radiograph.


Marked cardiomegaly with an enlarged pulmonary artery, consistent with pulmonary hypertension.


Pulmonary hypertension is hemodynamically defined as a mean pulmonary artery pressure greater than 25 mm Hg at rest or greater than 30 mm Hg during exercise, with increased pulmonary vascular resistance. The diagnosis is made with clinical assessment of hemodynamic parameters, medical history, and histologic findings. Enlarged central pulmonary arteries with rapid pruning of peripheral pulmonary arteries is a common finding; the heart size may be normal early on in the disease, with cardiomegaly from right ventricular hypertrophy at later stages.

On plain radiographs, a normal pulmonary artery should be smaller in diameter than the ascending aorta. In this case, the main pulmonary artery is larger than the aorta, which is consistent with pulmonary hypertension. Review of the patient's clinical history revealed a documented right ventricular pressure of 80 mm Hg, which is severely elevated.

The prognosis for untreated pulmonary hypertension is poor. There is only a 30% response to medical treatment. Interestingly, the most common worldwide cause for pulmonary hypertension is schistosomiasis.


  1. Frazier AA, Galvin JR, Franks TJ, Rosado-De-Christenson ML. From the archives of the AFIP: pulmonary vasculature: hypertension and infarction. Radiographics. 2000 Mar-Apr;20(2):491-524; quiz 530-1, 532. PMID: 10715347

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