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Chronic thromboembolic pulmonary hypertension — ABIM Board MCQ

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HardCardiovascularChronic thromboembolic pulmonary hypertensionABIM Board

A 61-year-old man has progressive exertional dyspnea 9 months after an unprovoked pulmonary embolism. Echocardiography shows RV enlargement and estimated pulmonary artery systolic pressure 62 mm Hg. CT pulmonary angiography shows no acute embolus. Which of the following is the most appropriate diagnostic study?

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Correct answer: A — Ventilation-perfusion lung scan

Chronic thromboembolic pulmonary hypertension can persist despite a negative CT for acute PE. V/Q scanning is the preferred screening test because a normal scan nearly excludes CTEPH.

Reference: 2022 ESC/ERS Pulmonary Hypertension Guideline; CHEST VTE Guidance