Radiographic Findings
A portable, frontal chest radiograph demonstrates an enlarged heart and markedly enlarged central pulmonary arteries consistent with pulmonary arterial hypertension. Although not seen in this reproduction, the left mainstem and left upper lobe bronchi are displaced inferiorly and laterally by the huge left pulmonary artery as it arches from anterior to posterior. The large descending (interlobar) segment of the left pulmonary artery is faintly seen behind the heart.
Note the rapid tapering of the peripheral
vessels compared to the central pulmonary arteries. This
rapid tapering associated with pulmonary arterial
hypertension gives a "pruned appearance" whether the
peripheral vessels appear small, normal, or mildly enlarged.
The absence of pulmonary artery dilation does not exclude
significant pulmonary arterial hypertension, and the degree
of arterial dilation does not always reflect the degree of
hypertension.
Reference
Hansell D, Peters A. Pulmonary vascular diseases and pulmonary edema. In: P Armstrong, A Wilson, P Dee, D Hansell (eds): Imaging of Diseases of the Chest, 2nd ed. St. Louis, Mosby-Year Book, 1996.
Clinical summary
Image 1