Example of a side-selective pulmonary artery angiogram (A and B right pulmonary artery, C and D left pulmonary artery) in digital subtraction technique of a patient with<unk> . Panels A and C represent anterior-posterior projections, panels B and D represent lateral projections. Early diagnosis still remains a challenge in<unk> , with a median time of 14 months between symptom onset and diagnosis in expert centres. A suspicion of PH is often raised by echocardiography, but an invasive right heart catheterisation is required to confirm it. Once PH is diagnosed, the presence of<unk>  disease requires imaging. The recommended diagnostic algorithm stresses the importance of initial investigation using an echocardiogram and V/Q scan and confirmation with right heart catheter and pulmonary angiography (PA). Both V/Q scanning and modern multidetector CT angiography (CTPA) may be accurate methods for the detection of<unk> , with excellent diagnostic efficacy in expert hands (sensitivity, specificity, and accuracy of 100%, 93.7%, and 96.5% for V/Q and 96.1%, 95.2%, and 95.6% for CTPA). However, CTPA alone cannot exclude the disease, but may help identify pulmonary artery distension resulting in left main coronary artery compression, pulmonary parenchymal lesions (e.g. as complications from previous pulmonary infarctions), and bleeding from bronchial collateral arteries. Today, the gold standard imaging remains invasive pulmonary angiography (PAG) using native angiograms or a digital subtraction technique.
Chronic thromboembolic pulmonary hypertension
Pulmonary hypertension
Portopulmonary hypertension
Pulmonary venoocclusive disease
Absent pulmonary valve syndrome
Bilharzial cor pulmonale
Asthma
Lettuce big-vein disease