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Diagnosis of chronic thromboembolic pulmonary hypertension

机译：慢性血栓栓塞性肺动脉高压的诊断

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Chronic thromboembolic pulmonary hypertension (CTEPH) is the only potentially curable form of pulmonary hypertension. Rapid and accurate diagnosis is pivotal for successful treatment. Clinical signs and symptoms can be nonspecific and risk factors such as history of venous thromboembolism may not always be present. Echocardiography is the recommended first diagnostic step. Cardiopulmonary exercise testing is a complementary tool that can help to identify patients with milder abnormalities and chronic thromboembolic disease; triggering the need for further investigation. Ventilation/perfusion (Vxe2x80xb2/Qxe2x80xb2) scintigraphy is the imaging methodology of choice to exclude CTEPH. Single photon emission computed tomography Vxe2x80xb2/Qxe2x80xb2 is gaining popularity over planar imaging. Assessment of pulmonary haemodynamics by right heart catheterisation is mandatory; although there is increasing interest in noninvasive haemodynamic evaluation. Despite the status of digital subtraction angiography as the gold standard; techniques such as computed tomography (CT) and magnetic resonance imaging are increasingly used for characterising the pulmonary vasculature and assessment of operability. Promising new tools include dual-energy CT; combination of rotational angiography and cone beam CT; and positron emission tomography. These innovative procedures not only minimise misdiagnosis; but also provide additional vascular information relevant to treatment planning. Further research is needed to determine how these modalities will fit into the diagnostic algorithm for CTEPH.
机译：慢性血栓栓塞性肺动脉高压（CTEPH）是唯一可能治愈的肺动脉高压形式。快速准确的诊断对于成功治疗至关重要。临床体征和症状可能是非特异性的，危险因素（例如静脉血栓栓塞史）可能并不总是存在。超声心动图是推荐的第一步诊断步骤。心肺运动测试是一种补充工具，可以帮助识别轻度异常和慢性血栓栓塞性疾病的患者。引发进一步调查的需要。通气/灌注（Vxe2x80xb2 / Qxe2x80xb2）闪烁显像是排除CTEPH的首选影像学方法。单光子发射计算机断层扫描Vxe2x80xb2 / Qxe2x80xb2在平面成像领域越来越受欢迎。必须通过右心导管检查评估肺血流动力学;尽管人们对无创血液动力学评估越来越感兴趣。尽管数字减影血管造影术已成为金标准;计算机断层扫描（CT）和磁共振成像等技术越来越多地用于表征肺血管和评估可操作性。有希望的新工具包括双能CT;旋转血管造影和锥形束CT的结合;和正电子发射断层扫描。这些创新的程序不仅最大程度地减少了误诊的可能性，而且还提供与治疗计划有关的其他血管信息。需要进一步研究以确定这些模式如何适合CTEPH的诊断算法。

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