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Original ResearchPulmonary HypertensionPericardial Abnormalities Predict the Presence of Echocardiographically Defined Pulmonary Arterial Hypertension in Systemic Sclerosis-Related Interstitial Lung Disease
Section snippets
Subjects
We identified 41 subjects who consented to enroll in our institutional review board-approved and Health Insurance Portability and Accountability Act-compliant ILD database with SSc-related ILD who had undergone a comprehensive evaluation that included the following: history and physical examination, rheumatologic serologic testing, pulmonary function testing, thoracic HRCT imaging, and transthoracic echocardiography (TTE). All were seen at National Jewish Medical and Research Center between
Results
Twenty four of 41 subjects (59%) had an abnormal pericardium by HRCT. Twenty of 41 subjects (49%) had a PEf, 23 of 41 subjects (56%) had an abnormal APR, and 20 of 41 subjects (49%) had an abnormal TPS.
An abnormal pericardium was more common in men than women. Subjects with and without pericardial abnormalities were otherwise similar with respect to age, SSc classification, autoantibodies, ILD pattern, presence of esophageal dilation, and pulmonary physiology (Table 1). Subjects with
Discussion
SSc patients commonly have asymptomatic pericardial abnormalities (reviewed by Deswal and Follansbee8), with autopsy series reporting a prevalence of 33 to 72%.8910111213 Fibrinous pericarditis, fibrous pericarditis, pericardial adhesions, and pericardial effusions have all been described.11 Screening echocardiographic evaluations have shown a prevalence of asymptomatic PEf of 13 to 55%.814151617 The prevalence of symptomatic pericardial abnormalities is much less prevalent, with studies8101112
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Lung disease related to connective tissue diseases
2019, Difficult to Diagnose Rare Diffuse Lung DiseaseACR Appropriateness Criteria<sup>®</sup> Suspected Pulmonary Hypertension
2017, Journal of the American College of RadiologyCitation Excerpt :Other findings suggesting PH on CT/CTPA include a ratio of segmental pulmonary artery to accompanying bronchus >1:1, mosaic attenuation of the lungs, pericardial thickening or effusion, enlargement of the right ventricle, and straightening of the interventricular septum. Enlargement of the bronchial arteries to a diameter of >1.5 mm can also be seen in patients with PH [3,22,40,44-46]. Extrinsic compression of the left main coronary artery by a dilated main pulmonary artery, an uncommon finding in PH, has also been reported on CT [47].
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2015, Rheumatology: Sixth EditionChronic pulmonary emboli and radiologic mimics on CT pulmonary angiography: A diagnostic challenge
2013, ChestCitation Excerpt :An important caveat is that reflux into the IVC may be noted in normal patients when the rate of contrast injection exceeds 3 mL/s.30 However, the presence of the contrast in the distal hepatic veins is unlikely to occur in the absence of tricuspid regurgitation or right-sided heart strain.27 Right ventricle function can deteriorate even in the absence of repeat embolic events, believed to be due to the formation of vascular lesions in the nonoccluded pulmonary vascular bed.30 Thrombus formation may occur within the dilated cardiac chambers and, with time, may calcify.29
Assessment of Pulmonary Hypertension. What CT and MRI Can Provide
2011, Academic RadiologyCitation Excerpt :A mosaic parenchymal attenuation pattern is sometimes present, reflecting inhomogeneous perfusion. A large amount of fluid within the anterior pericardial recess is also seen more frequently in patients with PH than in normal individuals (10,11). Precapillary PH includes many causes.
None of the authors have any financial or other potential conflicts of interest to disclose.