Role of Cardiovascular CT in Pulmonary Hypertension

Pulmonary hypertension (PH) is a disease in which there is an elevated pressure in the pulmonary vasculature leading to anatomic changes that can be identified on imaging. While right heart catheterization (RHC) is the gold standard for definitive diagnosis, there are many steps prior to catheterization in evaluating a patient with suspected PH. Computed Tomography (CT) is often used as one of the initial imaging modalities in the workup of suspected PH and is usually obtained in all patients with suspected or confirmed PH. In other cases, CT scans done for other purposes can suggest findings of PH that would alert clinicians to an additional possible diagnosis. Patients diagnosed with PH often have very complex hemodynamics as well as medical comorbidities, and referral to a center that specializes in PH is always recommended. There have been newly proposed classifications for the different groups of PH as well as a new definition for the diagnosis of PH. Various findings may require a specific CT to be completed with or without contrast or an electrocardiogram (ECG)-gated CT. This article reviews the current literature and provides a pictorial reference of CT findings associated with PH that can lead to a proposed diagnosis and, possibly, the underlying etiology of PH.