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Journal of Radiological Review 2021 June;8(2):144-51

DOI: 10.23736/S2723-9284.21.00123-9


language: English

Interstitial lung diseases and pulmonary hypertension

Adele VALENTINI 1, Giovanni SAVIETTO 2 , Federica MELONI 3, 4, Roberto DORE 5, Andrea BORGHESI 6, 7, Chiara ROMEI 8, Ilaria PULZATO 9, Cristiano RAMPINELLI 10, Lorenzo PREDA 1, 2, Anna Rita LARICI 11, 12

1 Department of Radiology, San Matteo Polyclinic Foundation IRCCS, Pavia, Italy; 2 Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy; 3 Department of Respiratory Diseases, IRCCS Polyclinic San Matteo Foundation, Pavia, Italy; 4 Section of Pneumology, Department of Internal Medicine, University of Pavia, Pavia, Italy; 5 Unit of Radiology, Clinical Institute “Città di Pavia,” Pavia, Italy; 6 Operative Unit of Diagnostic Radiology 2, ASST Spedali Civili of Brescia, Brescia, Italy; 7 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; 8 Department of Diagnostic Imaging, Diagnostic Radiology 2, Pisa University Hospital, Pisa, Italy; 9 General Radiology of the Levante, ASL1 Imperiese, Bussana di Sanremo, Sanremo, Imperia, Italy; 10 Department of Medical Imaging and Radiation Sciences, IEO, European Institute of Oncology IRCCS, Milan, Italy; 11 Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, “A. Gemelli” University Polyclinic Foundation IRCCS, Rome, Italy; 12 Department of Radiological and Hematological Sciences, Section of Radiology, Catholic University of the Sacred Heart of Rome, Rome, Italy

Pulmonary Hypertension (PH) is defined as an increase in the mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest, as assessed by the right heart catheterization (RHC), and it may complicate most cardiovascular and respiratory diseases. PH is clinically classified into five groups according to similar clinical presentation, pathological findings, hemodynamic characteristics and treatment strategy. Interstitial Lung Disease (ILD) are listed in Group 3 (due to lung diseases and/or hypoxia) and Group 5 (with unclear and/or multifactorial mechanisms), based on the physio-pathological mechanisms of PH development, with a prevalent precapillary hemodynamic profile. In patients with ILD, the presence of PH is commonly associated with the advanced phase of the disease and an increase in morbidity and mortality. In the context of PH associated with parenchymal lung diseases, the diagnosis is relevant not only for the patients’ prognosis but also for the treatment choice because the use of vasodilator therapy in patients with chronic lung diseases is generally not recommended. Therefore, the role of the radiologist is to look for computed tomography (CT) signs suggestive of PH and to contribute to the identification of the possible cause of PH, becoming familiar with clinical, hemodynamical and physiological aspects of the different diseases.

KEY WORDS: Hypertension, pulmonary; Lung diseases, interstitial; Tomography, X-ray computed; Computed tomography angiography; Pulmonary fibrosis; Scleroderma, systemic

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