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CTEPH — RACP Adult Medicine MCQ

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HardRespiratoryCTEPHRACP Adult Medicine

A 55-year-old man presents with a 6-month history of progressive exertional dyspnoea. PFTs show FVC 95% predicted, FEV1 90% predicted, FEV1/FVC 0.78, and DLCO 48% predicted. HRCT chest shows ground-glass opacification with a mosaic attenuation pattern. What is the most likely diagnosis?

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Correct answer: A — Chronic thromboembolic pulmonary hypertension

An isolated severely reduced DLCO with preserved spirometry and mosaic attenuation on HRCT is suggestive of chronic thromboembolic pulmonary hypertension (CTEPH). Mosaic attenuation reflects differential perfusion. The preserved FVC and FEV1 exclude significant parenchymal lung disease. V/Q scan is the screening test (more sensitive than CTPA for CTEPH). Right heart catheterisation confirms the diagnosis. Pulmonary endarterectomy is potentially curative.

Reference: eTG – 2025 – Respiratory; ESC/ERS – 2022 – Pulmonary Hypertension Guidelines