Differential Diagnosis for Chest CT Scan Findings
The provided chest CT scan findings suggest a complex condition affecting the cardiovascular and respiratory systems. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Pulmonary arterial hypertension (PAH): The marked increase in cardiac dimensions, particularly the right ventricle, and the disproportionate increase in the pulmonary circulatory system are characteristic of PAH. The ectatic pulmonary arteries and right ventricular enlargement are consistent with this diagnosis.
- Other Likely diagnoses
- Chronic thromboembolic pulmonary hypertension (CTEPH): The enlargement of the pulmonary arteries and the right ventricle could be due to chronic thromboembolic disease. However, the absence of mention of thrombi or emboli in the provided findings makes PAH more likely.
- Congenital heart disease with pulmonary hypertension: Although less likely given the patient's age, certain congenital heart diseases can lead to pulmonary hypertension and similar radiographic findings.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism (PE): Although the findings do not directly suggest PE, it is crucial to consider this diagnosis due to its high mortality rate if left untreated. The enlargement of the pulmonary arteries could be a sign of a large or multiple PEs.
- Cardiac tamponade: The marked increase in cardiac dimensions could be due to a pericardial effusion leading to tamponade, which is a life-threatening condition.
- Rare diagnoses
- Lymphangioleiomyomatosis (LAM): This rare condition can cause air trapping and pulmonary hypertension, but it is less likely given the patient's presentation and the absence of other characteristic findings such as renal angiomyolipomas.
- Pulmonary veno-occlusive disease (PVOD): This rare condition can cause pulmonary hypertension and similar radiographic findings, but it is less common and often associated with other symptoms such as hemoptysis.