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

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