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 8 months after a treated pulmonary embolism. Echocardiography shows RV dilatation and estimated pulmonary artery systolic pressure 58 mmHg. CT pulmonary angiography is equivocal for chronic thrombus. What is the most appropriate investigation?

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Correct answer: A — 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—“Spirometry alone, within a respiratory pathway”, “D-dimer to exclude chronic thromboembolic disease”, “Repeat troponin and discharge if normal”, “overnight respiratory polygraphy as the initial 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