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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 nine months after a treated pulmonary embolism. Echocardiography shows right ventricular dilatation and estimated pulmonary artery systolic pressure 62 mmHg. CT pulmonary angiography at the acute event showed bilateral emboli; she has been adherent with anticoagulation. Spirometry is normal and TLCO is mildly reduced. What is the most appropriate investigation?

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Correct answer: D — Ventilation-perfusion scan

The best answer is “Ventilation-perfusion scan”. Ventilation-perfusion scan is the investigation that most directly resolves the remaining diagnostic or staging uncertainty at this point in the pathway. The alternatives address different questions, have lower expected yield, or would be premature before this result. The remaining choices—“Methacholine challenge, within a respiratory pathway”, “Repeat D-dimer testing”, “Sputum cytology, after specialist assessment”, “Overnight oximetry as the sole test”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

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