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Sarcoidosis-associated pulmonary hypertension — SCE Respiratory MCQ

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HardThoracic ImagingSarcoidosis-associated pulmonary hypertensionSCE Respiratory

A patient with fibrotic sarcoidosis has estimated RVSP 68 mmHg, RV dilatation and TLCO 27% despite FVC 70%. Which test is required before pulmonary-hypertension-specific treatment is considered?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Right-heart catheterisation to measure mPAP, PAWP and PVR

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

A is correct. Echo, disproportionate TLCO reduction and RV change raise suspicion, but right-heart catheterisation confirms PH and separates pre- from post-capillary physiology using mPAP, PAWP and PVR. ACE is neither sensitive nor specific. CT assesses vascular and parenchymal causes but not complete haemodynamics. Walk distance and DLCO provide severity/prognosis, not diagnostic confirmation.

Reference: 2022 ESC/ERS pulmonary hypertension guideline: https://academic.oup.com/eurheartj/article/43/38/3618/6673929