Correct!
3. CT pulmonary angiography
CT pulmonary angiography represents the next most appropriate step for the evaluation of this patient. Catheter pulmonary angiography identified narrowing of the left pulmonary arterial system with upper and lower lobe vascular occlusions; the cause of these findings may be readily identified at thoracic CT. Thoracic MRI and MRA could provide information similar to enhanced thoracic CT, but CT offers superior depiction of the hilum of perivascular tissues and therefore would be preferred. Because the findings seen at catheter pulmonary angiography were vascular and perivascular in nature, bronchoscopy would not be the next test to obtain. As noted previously, echocardiography would prove useful in this patient, although probably less so now following right heart catheterization, and would not allow confident identification of the abnormalities producing the vascular findings seen at catheter pulmonary angiography. 18FDG-PET could eventually play a role in the evaluation of this patient, after the perivascular abnormalities are better characterized, but PET scan results are often more rewarding following clarification of the anatomy with CT first, so 18FDG-PET is premature at this point.
The patient underwent CT pulmonary angiography (Figure 5).
Figure 5. A-H (upper left): Axial enhanced CT pulmonary angiography displayed in soft tissue windows. I-P (upper right): Axial enhanced CT pulmonary angiography displayed in lung windows. Lower left: Video of CT pulmonry angiogram in soft tissue windows. Lower right: Video of CT pulmonary angiogram in lung windows.
Which of the following represents the most appropriate description for the thoracic CT pattern present? (Click on the correct answer to proceed to the eighth of nine pages)