Cavitating Lung Lesions in Chronic Thromboembolic Pulmonary Hypertension

Purpose: The aim of this study is to assess the incidence and natural history of cavitating lung lesions in chronic thromboembolic pulmonary hypertension (CTEPH), note thrombus position between patients with and without a cavity and determine whether their development is a predictor of mortality. Materials & Methods: All patients with confirmed CTEPH attending our Pulmonary Vascular Unit between February 1998 and January 2006 were identified, and a review of their notes and imaging was performed. Thrombus position, pre-disposing factors, cavity progression and mortality were noted, and comparisons made between those with and without a cavity. Results: 11 of 104 patients had a cavity (10.6%). Thrombus distribution was similar between those with and those without a cavity. Preceding infection was not proven in most cases. 27.3% of patients with a cavity died compared to 26.8% of those without. Conclusion: Cavity formation in CTEPH is 3 times more common than in acute pulmonary embolism. Thrombus position does not predict cavity development, and the presence of a cavity may serve as an indicator of disease severity but does not appear to predict mortality.