Pulmonary hypertension (PH) is a rare, life-threatening condition characterized by high blood pressure in the lungs and measured according to a resting mean pulmonary arterial pressure of 25 mmHg or greater at right heart catheterization. The disease is associated with damage to the pulmonary arteries, which are responsible for transporting blood from the heart to the lungs. The pulmonary arteries become narrowed and blocked, forcing the heart to work under stress.
Due to the excessive effort made by the heart to effectively pump blood, the organ may become enlarged and weakened. Detecting the disease earlier can help improve patients’ symptoms and quality of life. Diagnosis of PH is not easy, however, and there are numerous obstacles to early PH diagnosis. The disease cannot be detected in a regular medical check up, as the symptoms are often mistaken by other heart or lung conditions. There are more accurate exams that help diagnose PH, however, including chest x-rays or radiography.
Pulmonary Hypertension and Chest X-Rays: Diagnosis
When a patient demonstrates symptoms such as shortness of breath (dyspnea), fatigue, dizziness or fainting spells (syncope), chest pressure or pain, swelling (edema) in the ankles, legs and your abdomen (ascites), bluish color to the lips and skin (cyanosis), or irregular heartbeat, physicians may suspect of pulmonary hypertension. To confirm the diagnosis, several exams are conducted, with “diagnostic imaging targeting the right ventricle and the pulmonary vasculature,” as explained in the study “Imaging in Pulmonary Hypertension.” It is in this diagnostic approach that chest x-rays are used to diagnose pulmonary hypertension.
“Although echocardiography is cost-effective for screening and follow-up, right heart catheterization is still mandatory to differentiate pre- from post-capillary disease and to directly measure pressure and flow,” the study continues. “An important goal is to rule out chronic thromboembolic pulmonary hypertension. This diagnostic step can be achieved by perfusion scintigraphy, whereas computed tomography and cardiac magnetic resonance have become indispensable (…) Although of low sensitivity and specificity, a plain chest X-ray film can reveal significant pulmonary vascular pathology by illustrating vessel displacement and hyper- or hypovascularity of the lungs.”
Observations in Pulmonary Hypertension and Chest X-Rays
A chest x-ray is an imaging technique that uses electromagnetic radiation to analyze the internal structure of the chest. It is used to identify signs like a dilated right heart, which is related to right ventricular enlargement and retrosternal space on the lateral image. Similarly, right atrial enlargement is a sign of tricuspid regurgitation characteristic of patients with PH. Physicians are also particularly attentive for widened right heart border in the frontal projection and enlargement of the right atrial appendage, which is identified by an increased retrosternal opacity above the expected location of the right ventricle.
In addition, physicians may also find enlarged central pulmonary arteries, peripheral vessel opacity-oligemic lung fields, asymmetrical oligemia, increased transverse diameter of the right interlobar artery, right atrial dilatation and right ventricular dilatation, and Kerley B lines. Different images can reveal not only the presence of pulmonary hypertension, but also other lung and heart conditions that can result in the development of pulmonary hypertension. When the chest x-ray shows evidence of pulmonary hypertension, physicians usually request further examination to confirm the diagnostic.
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