Chronic thrombo-embolic pulmonary disease (CTED) with or without pulmonary hypertension (CTEPH) should be included in the differential when working up a patient with dyspnea of unclear origin. Prior history of venous thrombo- embolic (VTE) disease or other risk factors for thrombophilia are often present in such patients but approximately one-third of patients diagnosed with CTEPH don’t recall a prior index VTE event. Ventilation perfusion scan is a useful screening test for chronic thrombo-embolic pulmonary disease. In this conversation below: we present a patient with chronic thrombo-embolic disease and discuss how chronic thrombo-embolic disease is worked up. We explain how exercise testing is useful in characterizing a clinical phenotype in such patients and how we decide between open surgery, balloon pulmonary angioplasty, and pulmonary vasodilator therapy.
All authors: Vikas Aggarwal, MD, FSCAI and Robert Frantz, MD (Director of Pulmonary HTN at Mayo)
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