HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bugnone, A. N. Articles by Garcia, H. Search for Related Content PubMed PubMed Citation Articles by Bugnone, A. N. Articles by Garcia, H.

Imaging Findings in Human Immunodeficiency Virus–related Pulmonary Hypertension: Report of Five Cases and Review of the Literature¹

¹ From the Mount Sinai Medical Center of Miami, 4300 Alton Rd, Radiology Bldg, Office 218, Miami Beach, FL 33140. Received May 11, 2001; revision requested June 25; revision received August 17; accepted September 7. Address correspondence to A.N.B. (e-mail: bugnonea@hotmail.com).

View larger version (124K): [in a new window]   Figure 1a. Case 1. A 28-year-old woman in whom PH was the first manifestation of HIV infection. (a) Posteroanterior chest radiograph reveals marked cardiomegaly and an enlarged pulmonary trunk (arrowhead). The right interlobar artery (arrow) measures 21 mm in transverse diameter. (b) Posteroanterior chest radiograph obtained 5 years later shows interval progression of the cardiomegaly. (c-e) Electron-beam CT pulmonary angiograms (130 keV, 633 mA, 3-mm collimation, 0.2-second exposure). (c) Transverse view at the level of the bifurcation of the pulmonary artery (window width, 500 HU; window level, 40 HU) shows enlargement of the main pulmonary artery (pa), which measures 43 mm in transverse diameter (dashed line). (d) Transverse image obtained at a lower level (window width, 500 HU; window level, 40 HU) shows dilatation of the right ventricle (rv) and right atrium (ra) and reversal of the interatrial (straight arrow) and interventricular (curved arrow) septa. Simultaneous opacification of the right and left cardiac chambers is noted. lv = left ventricle, la = left atrium. (e) Segmental artery-to-bronchus ratios greater than 1 (arrows) in the lower lobes can be observed on this transverse image obtained at a lower level (window width, 1,400 HU; window level, -300 HU). (f) A four-chamber view from an echocardiogram shows right ventricular (rv) and right atrial (ra) dilatation. Paradoxical movement of the interventricular septum (arrowhead) was observed at real-time imaging.

View larger version (119K): [in a new window]   Figure 1b. Case 1. A 28-year-old woman in whom PH was the first manifestation of HIV infection. (a) Posteroanterior chest radiograph reveals marked cardiomegaly and an enlarged pulmonary trunk (arrowhead). The right interlobar artery (arrow) measures 21 mm in transverse diameter. (b) Posteroanterior chest radiograph obtained 5 years later shows interval progression of the cardiomegaly. (c-e) Electron-beam CT pulmonary angiograms (130 keV, 633 mA, 3-mm collimation, 0.2-second exposure). (c) Transverse view at the level of the bifurcation of the pulmonary artery (window width, 500 HU; window level, 40 HU) shows enlargement of the main pulmonary artery (pa), which measures 43 mm in transverse diameter (dashed line). (d) Transverse image obtained at a lower level (window width, 500 HU; window level, 40 HU) shows dilatation of the right ventricle (rv) and right atrium (ra) and reversal of the interatrial (straight arrow) and interventricular (curved arrow) septa. Simultaneous opacification of the right and left cardiac chambers is noted. lv = left ventricle, la = left atrium. (e) Segmental artery-to-bronchus ratios greater than 1 (arrows) in the lower lobes can be observed on this transverse image obtained at a lower level (window width, 1,400 HU; window level, -300 HU). (f) A four-chamber view from an echocardiogram shows right ventricular (rv) and right atrial (ra) dilatation. Paradoxical movement of the interventricular septum (arrowhead) was observed at real-time imaging.

View larger version (107K): [in a new window]   Figure 1c. Case 1. A 28-year-old woman in whom PH was the first manifestation of HIV infection. (a) Posteroanterior chest radiograph reveals marked cardiomegaly and an enlarged pulmonary trunk (arrowhead). The right interlobar artery (arrow) measures 21 mm in transverse diameter. (b) Posteroanterior chest radiograph obtained 5 years later shows interval progression of the cardiomegaly. (c-e) Electron-beam CT pulmonary angiograms (130 keV, 633 mA, 3-mm collimation, 0.2-second exposure). (c) Transverse view at the level of the bifurcation of the pulmonary artery (window width, 500 HU; window level, 40 HU) shows enlargement of the main pulmonary artery (pa), which measures 43 mm in transverse diameter (dashed line). (d) Transverse image obtained at a lower level (window width, 500 HU; window level, 40 HU) shows dilatation of the right ventricle (rv) and right atrium (ra) and reversal of the interatrial (straight arrow) and interventricular (curved arrow) septa. Simultaneous opacification of the right and left cardiac chambers is noted. lv = left ventricle, la = left atrium. (e) Segmental artery-to-bronchus ratios greater than 1 (arrows) in the lower lobes can be observed on this transverse image obtained at a lower level (window width, 1,400 HU; window level, -300 HU). (f) A four-chamber view from an echocardiogram shows right ventricular (rv) and right atrial (ra) dilatation. Paradoxical movement of the interventricular septum (arrowhead) was observed at real-time imaging.

View larger version (122K): [in a new window]   Figure 1d. Case 1. A 28-year-old woman in whom PH was the first manifestation of HIV infection. (a) Posteroanterior chest radiograph reveals marked cardiomegaly and an enlarged pulmonary trunk (arrowhead). The right interlobar artery (arrow) measures 21 mm in transverse diameter. (b) Posteroanterior chest radiograph obtained 5 years later shows interval progression of the cardiomegaly. (c-e) Electron-beam CT pulmonary angiograms (130 keV, 633 mA, 3-mm collimation, 0.2-second exposure). (c) Transverse view at the level of the bifurcation of the pulmonary artery (window width, 500 HU; window level, 40 HU) shows enlargement of the main pulmonary artery (pa), which measures 43 mm in transverse diameter (dashed line). (d) Transverse image obtained at a lower level (window width, 500 HU; window level, 40 HU) shows dilatation of the right ventricle (rv) and right atrium (ra) and reversal of the interatrial (straight arrow) and interventricular (curved arrow) septa. Simultaneous opacification of the right and left cardiac chambers is noted. lv = left ventricle, la = left atrium. (e) Segmental artery-to-bronchus ratios greater than 1 (arrows) in the lower lobes can be observed on this transverse image obtained at a lower level (window width, 1,400 HU; window level, -300 HU). (f) A four-chamber view from an echocardiogram shows right ventricular (rv) and right atrial (ra) dilatation. Paradoxical movement of the interventricular septum (arrowhead) was observed at real-time imaging.

View larger version (127K): [in a new window]   Figure 1e. Case 1. A 28-year-old woman in whom PH was the first manifestation of HIV infection. (a) Posteroanterior chest radiograph reveals marked cardiomegaly and an enlarged pulmonary trunk (arrowhead). The right interlobar artery (arrow) measures 21 mm in transverse diameter. (b) Posteroanterior chest radiograph obtained 5 years later shows interval progression of the cardiomegaly. (c-e) Electron-beam CT pulmonary angiograms (130 keV, 633 mA, 3-mm collimation, 0.2-second exposure). (c) Transverse view at the level of the bifurcation of the pulmonary artery (window width, 500 HU; window level, 40 HU) shows enlargement of the main pulmonary artery (pa), which measures 43 mm in transverse diameter (dashed line). (d) Transverse image obtained at a lower level (window width, 500 HU; window level, 40 HU) shows dilatation of the right ventricle (rv) and right atrium (ra) and reversal of the interatrial (straight arrow) and interventricular (curved arrow) septa. Simultaneous opacification of the right and left cardiac chambers is noted. lv = left ventricle, la = left atrium. (e) Segmental artery-to-bronchus ratios greater than 1 (arrows) in the lower lobes can be observed on this transverse image obtained at a lower level (window width, 1,400 HU; window level, -300 HU). (f) A four-chamber view from an echocardiogram shows right ventricular (rv) and right atrial (ra) dilatation. Paradoxical movement of the interventricular septum (arrowhead) was observed at real-time imaging.

View larger version (139K): [in a new window]   Figure 1f. Case 1. A 28-year-old woman in whom PH was the first manifestation of HIV infection. (a) Posteroanterior chest radiograph reveals marked cardiomegaly and an enlarged pulmonary trunk (arrowhead). The right interlobar artery (arrow) measures 21 mm in transverse diameter. (b) Posteroanterior chest radiograph obtained 5 years later shows interval progression of the cardiomegaly. (c-e) Electron-beam CT pulmonary angiograms (130 keV, 633 mA, 3-mm collimation, 0.2-second exposure). (c) Transverse view at the level of the bifurcation of the pulmonary artery (window width, 500 HU; window level, 40 HU) shows enlargement of the main pulmonary artery (pa), which measures 43 mm in transverse diameter (dashed line). (d) Transverse image obtained at a lower level (window width, 500 HU; window level, 40 HU) shows dilatation of the right ventricle (rv) and right atrium (ra) and reversal of the interatrial (straight arrow) and interventricular (curved arrow) septa. Simultaneous opacification of the right and left cardiac chambers is noted. lv = left ventricle, la = left atrium. (e) Segmental artery-to-bronchus ratios greater than 1 (arrows) in the lower lobes can be observed on this transverse image obtained at a lower level (window width, 1,400 HU; window level, -300 HU). (f) A four-chamber view from an echocardiogram shows right ventricular (rv) and right atrial (ra) dilatation. Paradoxical movement of the interventricular septum (arrowhead) was observed at real-time imaging.

View larger version (116K): [in a new window]   Figure 2. Case 2. A 48-year-old man in whom PH was the first manifestation of HIV infection. Posteroanterior chest radiograph shows slight prominence of central pulmonary arteries; the right interlobar artery (arrow) measures 19 mm in transverse diameter.

View larger version (88K): [in a new window]   Figure 3a. Case 3. A 30-year-old man with HIV and PH. (a) Transverse CT pulmonary angiogram (120 keV; 240 mA; 3-mm collimation; window width, 400 HU; window level, 40 HU) demonstrates pericardial effusion (arrow) and right ventricular (rv) dilatation. (b) Selective left pulmonary angiogram obtained in an anteroposterior orientation demonstrates an enlarged left pulmonary artery (lpa) and pruning of the vascular tree in the peripheral vessels, predominantly in the lower lobe branches (arrowheads). Similar findings were observed on the right-side angiogram.

View larger version (130K): [in a new window]   Figure 3b. Case 3. A 30-year-old man with HIV and PH. (a) Transverse CT pulmonary angiogram (120 keV; 240 mA; 3-mm collimation; window width, 400 HU; window level, 40 HU) demonstrates pericardial effusion (arrow) and right ventricular (rv) dilatation. (b) Selective left pulmonary angiogram obtained in an anteroposterior orientation demonstrates an enlarged left pulmonary artery (lpa) and pruning of the vascular tree in the peripheral vessels, predominantly in the lower lobe branches (arrowheads). Similar findings were observed on the right-side angiogram.

View larger version (128K): [in a new window]   Figure 4a. Case 4. A 40-year-old HIV-positive man with no pulmonary symptoms. (a) Posteroanterior chest radiograph shows an enlarged pulmonary trunk (straight arrow) without evidence of central pulmonary artery enlargement; the right interlobar artery (curved arrow) measures 16 mm. (b) A posteroanterior chest radiograph obtained 3 years later shows slight dilatation of the central pulmonary arteries. The right interlobar artery (arrow) measures 20 mm. (c) Transverse CT pulmonary angiogram (120 keV; 240 mA; 3-mm collimation; window width, 400 HU; window level, 40 HU) demonstrates an enlarged main pulmonary artery (pa), which measures 35 mm at the level of the bifurcation.

View larger version (126K): [in a new window]   Figure 4b. Case 4. A 40-year-old HIV-positive man with no pulmonary symptoms. (a) Posteroanterior chest radiograph shows an enlarged pulmonary trunk (straight arrow) without evidence of central pulmonary artery enlargement; the right interlobar artery (curved arrow) measures 16 mm. (b) A posteroanterior chest radiograph obtained 3 years later shows slight dilatation of the central pulmonary arteries. The right interlobar artery (arrow) measures 20 mm. (c) Transverse CT pulmonary angiogram (120 keV; 240 mA; 3-mm collimation; window width, 400 HU; window level, 40 HU) demonstrates an enlarged main pulmonary artery (pa), which measures 35 mm at the level of the bifurcation.

View larger version (65K): [in a new window]   Figure 4c. Case 4. A 40-year-old HIV-positive man with no pulmonary symptoms. (a) Posteroanterior chest radiograph shows an enlarged pulmonary trunk (straight arrow) without evidence of central pulmonary artery enlargement; the right interlobar artery (curved arrow) measures 16 mm. (b) A posteroanterior chest radiograph obtained 3 years later shows slight dilatation of the central pulmonary arteries. The right interlobar artery (arrow) measures 20 mm. (c) Transverse CT pulmonary angiogram (120 keV; 240 mA; 3-mm collimation; window width, 400 HU; window level, 40 HU) demonstrates an enlarged main pulmonary artery (pa), which measures 35 mm at the level of the bifurcation.

View larger version (152K): [in a new window]   Figure 5. Case 5. A 40-year-old man with a 14-year history of HIV and a 10-month history of exertional dyspnea. Posteroanterior chest radiograph demonstrates moderate cardiomegaly and enlargement of the pulmonary trunk (straight arrow) and hilar pulmonary arteries. The curved arrow indicates the right pulmonary artery.