Ebook Clinically oriented pulmonary imaging: Part 2
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Ebook Clinically oriented pulmonary imaging: Part 2
Imaging of Pulmonary HypertensionMark L. Schiebler, James Runo, Leif Jensen, and Christopher J. Francois9AbstractPulmonary hypertension (PH) is a sile Ebook Clinically oriented pulmonary imaging: Part 2ent disease with many causes that comes to clinical attention late in its course. There are indirect features of PH found on noninvasive imaging studies, but the diagnosis of this disease and its therapeutic management still require right heart catheterization with pressure measurements of the pulmo Ebook Clinically oriented pulmonary imaging: Part 2nary artery. In general, with chronic PI I. the main pulmonary artery is enlarged, there is tapering of the peripheral pulmonary arteries, there is deEbook Clinically oriented pulmonary imaging: Part 2
creased vessel compliance from muscular hypertrophy of die arterial walls, and there is reduced pulmonary blood flow. 'Illis is accompanied by changesImaging of Pulmonary HypertensionMark L. Schiebler, James Runo, Leif Jensen, and Christopher J. Francois9AbstractPulmonary hypertension (PH) is a sile Ebook Clinically oriented pulmonary imaging: Part 2such as with massive pulmonary emboli, (he abrupt change in pulmonary arterial pressure has a dramatic effect on right heart contractility. 'Hie peak velocity of the tricuspid regurgitation jet. as measured by echocardiography or MR1. is loosely correlated w ith pulmonary arterial pressure. Untreate Ebook Clinically oriented pulmonary imaging: Part 2d PH results in a rapid clinical decline with death frequently occurring within 3 years of diagnosis. Even with treatment the mean survival time is stEbook Clinically oriented pulmonary imaging: Part 2
ill less than 4 years.M. L. Schiebler (13) ■ c. J. FrancoisDepartment of Radiology.University of Wisconsin School of Medicine and Public Health, 600 HImaging of Pulmonary HypertensionMark L. Schiebler, James Runo, Leif Jensen, and Christopher J. Francois9AbstractPulmonary hypertension (PH) is a sile Ebook Clinically oriented pulmonary imaging: Part 2Wisconsin School of Medicine and Public Health. 5252 MFCB, 1685 Highland Avenue. Madison. W1 53705-2281, USAL. JensenDiagnostic Radiology, E.V366 Clinical Science Center.University of Wisconsin Madison. 600 Highland Avenue. Madison. WI 53792-3252. USAJ. p. Kanne (cd.). Clinically Oriented Pulmonary Ebook Clinically oriented pulmonary imaging: Part 2Imaging, Respiratory Medicine. DOI: 10.1007A>78-l-61779-542-8_9.© Humana Press, a part of springer Science+Business Media, LLC 2012139140M. L. SchieblEbook Clinically oriented pulmonary imaging: Part 2
er et al.KeywordsPulmonary hypertension • Pulmonary arterial hypertension • Chronic thromboembolic pulmonary hypertension • Eisenmenger syndrome • ComImaging of Pulmonary HypertensionMark L. Schiebler, James Runo, Leif Jensen, and Christopher J. Francois9AbstractPulmonary hypertension (PH) is a sile Ebook Clinically oriented pulmonary imaging: Part 2seases of the chest which the clinician can expect to encounter, pulmonary hypertension (PH) is a relatively rare phenomenon. While the extremely common disorder of systemic arterial hypertension (SAID is known as the “silent killer", one could give the moniker of the “invisible silent killer” to PH Ebook Clinically oriented pulmonary imaging: Part 2. The clinician and patient have the opportunity to screen for SAI 1 with a simple blood pressure cuff. Unfortunately, there is no simple screening teEbook Clinically oriented pulmonary imaging: Part 2
st to detect PH early in its course. The analogy to SAH is apt: just as the retinal vessels show pruning and amputation of the capillary bed in longstImaging of Pulmonary HypertensionMark L. Schiebler, James Runo, Leif Jensen, and Christopher J. Francois9AbstractPulmonary hypertension (PH) is a sile Ebook Clinically oriented pulmonary imaging: Part 2le hypertrophic narrowing of its feeding pulmonary arterioles. While there are many secondary lobules that must be similarly affected by this process before dyspnea sets in. there is no “turning back of the clock” once this disease manifests itself in the vascular bed of the lung 111. Thus the lesso Ebook Clinically oriented pulmonary imaging: Part 2ns learned from SAI I, a disease that leads to end stage arteriolar sclerosis in all the end organs of the body, encapsulates many of the issues the cEbook Clinically oriented pulmonary imaging: Part 2
linician must deal with while treating patients with symptomatic PH where irreversible end organ damage has usually already occurred to the pulmonary Imaging of Pulmonary HypertensionMark L. Schiebler, James Runo, Leif Jensen, and Christopher J. Francois9AbstractPulmonary hypertension (PH) is a sile Ebook Clinically oriented pulmonary imaging: Part 2riteria by which this diagnosis can be made arc as follows [2-4]:1Mean pulmonary' artery' pressure (mPAP) of >25 mmHg at rest2Pulmonary capillary wedge pressure (PCWP) <15 mmHg, or3Pulmonary vascular resistance (PVR) of >3 Wood units 11. 5J.Typically, at rest, the right heart is not able to generate Ebook Clinically oriented pulmonary imaging: Part 2 systolic PAP >40 mmHg acutely |6|. Thus, any mPAP of >40 mmHg implies chronic PH. The severity level of this condition is categorized by the amount oEbook Clinically oriented pulmonary imaging: Part 2
f mPAP at rest: Severe >50 mmHg. Moderate = 30 50 mmHg, and Mild <30 mmHg.The Dana Point 2009 Classification system makes subtle distinction between pImaging of Pulmonary HypertensionMark L. Schiebler, James Runo, Leif Jensen, and Christopher J. Francois9AbstractPulmonary hypertension (PH) is a sile Ebook Clinically oriented pulmonary imaging: Part 2) and r pulmonary veno-occlusive disease (PVOD) and/or pulmonary capillary hemangiomatosis (PCH): while the term pulmonary hypertension (PH) is reserved for categories 2-5 (sec Table 9.1). For the purposes of this publication, we combine these two entities (PAH & PH) under the moniker of PH for simp Ebook Clinically oriented pulmonary imaging: Part 2lification, as the distinction between PAH and PH in this classification scheme has a more semantic origin than physiologic meaning.EpidemiologyThe nuEbook Clinically oriented pulmonary imaging: Part 2
mber of de novo cases of pulmonary PH that come to the attention of clinicians pales in comparison to the frequency of COPD, asthma, pneumonia, lung cImaging of Pulmonary HypertensionMark L. Schiebler, James Runo, Leif Jensen, and Christopher J. Francois9AbstractPulmonary hypertension (PH) is a sile Ebook Clinically oriented pulmonary imaging: Part 2e so for developing9 Imaging of Pulmonary Hypertension141countries |7|. The frequency of occurrence of PH is difficult to measure as it is a silent disease until late in its course when most of the patients have severe functional and hemodynamic problems 18|. It is estimated that there arc more than Ebook Clinically oriented pulmonary imaging: Part 2 l(X).(X)() persons in the USA with this disease |9|, with one estimate as high as 1:2,000 individuals [10]. A separate study showed about 26 cases/miEbook Clinically oriented pulmonary imaging: Part 2
llion in the Scottish Isles (111- In the French registry, there were 15.0 cases/million adult inhabitants |8|. PH is one of the few vascular diseases Imaging of Pulmonary HypertensionMark L. Schiebler, James Runo, Leif Jensen, and Christopher J. Francois9AbstractPulmonary hypertension (PH) is a sile Ebook Clinically oriented pulmonary imaging: Part 2ng that PH involves females 80% of the time [13]. This disorder has also been linked to genetic mutations and thus can Ik- inherited [14, 15].Whi Ic some causes of PH arc amenable to cither medical or surgical treatment (chronic thromboembolic pulmonary hypertension (CTEPH) and left-to-right congeni Ebook Clinically oriented pulmonary imaging: Part 2tal shunts). PH frequently leads to premature death. In the USA over the 20-ycar reporting period of 1980-2000. tlie number of deaths and hospitalizatEbook Clinically oriented pulmonary imaging: Part 2
ions attributable to PH have increased [ I6|. The clinical features most predictive of survival are the 6-min walking test, the New York Heart AssociaImaging of Pulmonary HypertensionMark L. Schiebler, James Runo, Leif Jensen, and Christopher J. Francois9AbstractPulmonary hypertension (PH) is a sile Ebook Clinically oriented pulmonary imaging: Part 2g PI I was shown to be: 39.2% idiopathic, 15.3% connective tissue diseases. 11.3% congenital heart disease. 10.4% portal hypertension, 9.5% anorexigen [8. I8|. and 6.2% HIV assiociated |8|. Historically, without treatment, the estimated mean survival after diagnosis is 2.8 years 112, 19]. For untrea Ebook Clinically oriented pulmonary imaging: Part 2ted PH. the estimated 3-year survival rate from a 1991 study was approximately 41%. In one study of long-term continuous intravenous prostacyclin therEbook Clinically oriented pulmonary imaging: Part 2
apy. 3-ycar survival increased to approximately 63% [20]. rhe mean treated survival time is now reported to be 3.6 years [12].Imaging of Pulmonary HypertensionMark L. Schiebler, James Runo, Leif Jensen, and Christopher J. Francois9AbstractPulmonary hypertension (PH) is a sileImaging of Pulmonary HypertensionMark L. Schiebler, James Runo, Leif Jensen, and Christopher J. Francois9AbstractPulmonary hypertension (PH) is a sileGọi ngay
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