Pulmonary arterial hypertension: thin-section CT predictors of epoprostenol therapy failure

Radiology. 2002 Mar;222(3):782-8. doi: 10.1148/radiol.2223010668.


Purpose: To correlate pretherapeutic thin-section computed tomographic (CT) findings in patients with pulmonary hypertension with the risk of fatality with treatment with epoprostenol.

Materials and methods: Seventy-three consecutive patients with severe pulmonary hypertension treated with epoprostenol were retrospectively separated into two groups. The first group included 12 patients who had a fatal outcome with epoprostenol therapy. The second group (n = 61) was a reference group of patients with epoprostenol-induced clinical improvement. Pretherapeutic thin-section CT scans of each patient were reviewed.

Results: Poorly defined nodular opacities (P =.003), septal lines (P =.04), pleural effusion (P =.01), and adenopathy (P =.009) strongly correlated with a risk of clinical worsening with treatment. In six patients in group 1, postmortem examination of the lung revealed either pulmonary veno-occlusive disease or pulmonary capillary hemangiomatosis.

Conclusion: On pretherapeutic thin-section CT scans, poorly defined nodular opacities, septal lines, pleural effusion, and adenopathy should raise suspicion for pulmonary veno-occlusive disease or pulmonary capillary hemangiomatosis and provoke possible further evaluation before epoprostenol therapy.

MeSH terms

  • Adult
  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / therapeutic use*
  • Epoprostenol / adverse effects
  • Epoprostenol / therapeutic use*
  • Female
  • Humans
  • Hypertension, Pulmonary / complications
  • Hypertension, Pulmonary / diagnostic imaging*
  • Hypertension, Pulmonary / drug therapy
  • Lung / diagnostic imaging*
  • Male
  • Middle Aged
  • Pleural Effusion / diagnostic imaging
  • Pleural Effusion / etiology
  • Radiography, Thoracic
  • Retrospective Studies
  • Tomography, X-Ray Computed* / methods
  • Treatment Failure


  • Antihypertensive Agents
  • Epoprostenol