With a sensitivity of 96%-97%, V/PSCAN is accepted as the most effective screening tool in the CTEPH diagnostic algorithm. The diagnosis of CTEPH is suspected in patients with pulmonary hypertension when V/Q scanning shows one or several segmental or larger mismatched perfusion defects. This is unlike the mottled subsegmental defects associated with pulmonary arterial hypertension.
Although CT pulmonary angiography can visualize the pulmonary vasculature to assess for stenosis and obstruction, it cannot rule out the diagnosis of CTEPH. Pulmonary angiography is used to confirm the diagnosis of CTEPH and evaluate patients for surgery eligibility.
European Society of Cardiology Clinical Practice Guidelines recommend echocardiography as the first diagnostic step in the assessment pulmonary hypertension. However, it has limited value in identifying the specific cause of pulmonary hypertension.
Cardiac MRI is used to assess right ventricular size and systolic function. While this may be useful in the diagnostic workup and follow-up of CTEPH, cardiac MRI has not been integrated into the diagnostic algorithm.
Diagnostic delay has been demonstrated to negatively impact the prognosis of CTEPH and may contribute to the progression of vasculopathy that develops. A timely diagnosis is important for choosing the right treatment options in patients with suspected CTEPH.
Learn more about CTEPH.
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Cite this: Vikramjit Khangoora. Fast Five Quiz: Chronic Thromboembolic Pulmonary Hypertension - Medscape - May 17, 2022.