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Chronic thromboembolic pulmonary hypertension — SCE Respiratory MCQ

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HardPulmonary Vascular DiseaseChronic thromboembolic pulmonary hypertensionSCE Respiratory

A 58-year-old man remains breathless 9 months after a large PE despite adequate anticoagulation. Echocardiography suggests pulmonary hypertension and TLCO is reduced. CTPA is inconclusive for chronic thrombus. What is the most appropriate investigation?

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Correct answer: D — Ventilation-perfusion scan

A V/Q scan is highly sensitive for chronic thromboembolic pulmonary hypertension and is the appropriate screening investigation when CTEPH is suspected. Normal or non-diagnostic CTPA does not exclude CTEPH. Airway and pleural tests do not assess chronic thromboembolic obstruction.

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