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Chronic thromboembolic pulmonary hypertension — SCE Respiratory MCQ

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HardPulmonary Vascular DiseaseChronic thromboembolic pulmonary hypertensionSCE Respiratory

A 59-year-old woman remains breathless 6 months after an apparently treated pulmonary embolism. Echocardiography shows estimated pulmonary artery systolic pressure 62 mmHg and right ventricular enlargement. CTPA shows webs and bands in segmental pulmonary arteries. What is the most appropriate investigation?

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Correct answer: C — Ventilation-perfusion scan and referral to a CTEPH centre

Persistent dyspnoea, pulmonary hypertension and chronic thromboembolic changes suggest CTEPH; V/Q scanning is highly sensitive and referral to a specialist centre is appropriate. D-dimer is not a test for excluding chronic thromboembolic disease. Spirometry or bronchial challenge may investigate comorbidity but would miss a potentially operable pulmonary vascular disease.

Reference: ESC/ERS Pulmonary Hypertension Guideline 2022; NICE NG158