This patient fits the typical clinical and radiological profile of a patient with primary pulmonary hypertension. The pulmonary arteries are markedly enlarged with the right atrial chamber also enlarged. The normal right pulmonary descending artery diameter is less than 16 mm in males and 15 mm in females. The lung fields are clear and the lung volumes normal making lung disease causing pulmonary hypertension unlikely. Other causes to be ruled out are congenital heart disease and chronic pulmonary thromboembolism.
Case 33. This middle-aged male was involved in a motor vehicle accident where he was the driver and his vehicle was hit from behind resulting in intense chest pain. His CXR is shown (Fig. 33.1).
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