1. Pulmonary Arterial Hypertension
: The pressure in the pulmonary artery depends on *
.Cardiac output -1
.Pulmonary vascular resistance -2

2. Pulmonary Arterial Hypertension
Conditions that cause significant pulmonary arterial *
hypertension all increase the resistance of blood flow
: through the lungs, examples
.(Various lung diseases (cor pulmonale -1
.Pulmonary embolism -2
Pulmonary arterial narrowing in response to -3mitral
.valve diseases orLt. to Rt. shunt
.Idiopathic pulmonary hypertension -4

3. Pulmonary Arterial Hypertension
: By CXR *
There will be enlargement of the mean pulmonary artery +
the hilar pulmonary artery, vessels within the lung tissue
.are normal or small
: Eisenmenger's syndrome *
Greatly raised pulmonary artery resistance in association
withASD ,VSD , &PDA leading toreverse shunt (i.e. :Rt. to
.(Lt. shunt

4. Pulmonary Arterial Hypertension
The cause of pulmonary arterial hypertension may be *
visible on the CXR as cor pulmonale & mitral valve
.diseases
Pulmonary Arterial Hypertension
due to ASD & Eisenmenger's
syndrome

5. Pulmonary Venous Hypertension
The commonest causes of pulmonary venous hypertension *
: are
.Mitral valve diseases -1
.Lt. ventricular failure -2
normal upright person )by CXR ( thelower zone vessels In *
arelarger than theupper. zone
upper zone vessels In pulmonary venous hypertension the *
. areenlarged
severe cases , theupper zone vessels becomelarger In *
than that of thelower zone, & eventually Pulmonary
Edema .will supervene & may obscure the blood vessels

6. Pulmonary Venous Hypertension
Pulmonary Venous Hypertension
in a patient with Mitral Valve
Disease

7. Aorta
With aging the aorta becomes elongated, elongation *
necessarily involveunfolding , where theascending aorta
, will deviate to theRt. & thedescending aorta to the.Lt
because the aorta is fixed at theaortic valve & the
.diaphragm
.confused withaortic dilatation Unfolding aorta is easily *
: Aortic dilatation of the ascending aorta is due to *
.Aneurysm -1
.Aortic regurgitation or aortic stenosis -2
.Systemic hypertension -3
The two common causes of descending aortic aneurysm *
: are
.Atheroma -1
Aortic dissection. (Also, there is a rare cause as -2
.(previous trauma following decelerating injury

8. Aorta
: By CXR *
The diagnosis of aortic aneurysm may be obvious, but -1
substantial dilatation may be needed before the bulge of
.Rt. mediastinal border can be recognized
Atheromatous aneurysm invariably shows calcification of -2
.their walls
: Note
CT scan with IVCM orCT angiography orMRA are very *
.useful to assess the aneurysm
IVCM =I.V. C ontrastM.edia
MRA =M agnaticR esonanceA.ngiography

9. Dissecting Aortic Aneurysm
It is important to know the extent of the dissecting
aneurysm as those involving the ascending aorta are
treated surgically & those confined to the descending
.aorta are treated with hypotensive drugs
: By CXR *
: Two congenital aortic anomalies can be seen, & they are
.Coarctation of Aorta -1
,Rt. sided aortic arch, in association with TOF -2
Pulmonary Atresia, & Truncus Arteriosus, or it also
.can be isolated with no clinical significance

10. Dissecting Aortic Aneurysm
Trans-Esophageal
Echocardiogram showing
the True (T( & False (F(
lumina in the descending
aorta

11. Dissecting Aortic Aneurysm
CT-scan showing the displaced
intima (arrows( separating the
true & false luminae in the
ascending & descending aorta