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From PE to CTEPH

Learn more about the stages of progression of an acute clot to CTEPH, sometimes mistakenly referred to as "chronic clot" or "chronic PE".

  • Learn more about the stages of progression of an acute clot to CTEPH, sometimes mistakenly referred to as "chronic clot" or "chronic PE".

    Learn more about the stages of progression of an acute clot to CTEPH, sometimes mistakenly referred to as "chronic clot" or "chronic PE".
    Click to Play Video

  • Nick H. Kim, MD, of UCSD School of Medicine, provides a background understanding of chronic thromboembolic pulmonary hypertension, or CTEPH, including epidemiology, risk factors, and symptoms.

    Nick H. Kim, MD, of UCSD School of Medicine, provides a background understanding of chronic thromboembolic pulmonary hypertension, or CTEPH, including epidemiology, risk factors, and symptoms.
    Click to Play Video

  • Victor F. Tapson, MD, of Cedars-Sinai Medical Center, Los Angeles, looks at how CTEPH develops, how it manifests, and several important considerations in distinguishing CTEPH from PAH.

    Victor F. Tapson, MD, of Cedars-Sinai Medical Center, Los Angeles, looks at how CTEPH develops, how it manifests, and several important considerations in distinguishing CTEPH from PAH.
    Click to Play Video

  • Raymond L. Benza, MD, of Allegheny General Hospital, Pittsburgh, works through the differential diagnosis of CTEPH, outlining diagnostic difficulties and a helpful mnemonic device to guide clinicians.

    Raymond L. Benza, MD, of Allegheny General Hospital, Pittsburgh, works through the differential diagnosis of CTEPH, outlining diagnostic difficulties and a helpful mnemonic device to guide clinicians.
    Click to Play Video

  • William R. Auger, MD, of UCSD School of Medicine, discusses the use of V/Q scanning and right heart catheterization in diagnosing chronic thromboembolic pulmonary hypertension, or CTEPH.

    William R. Auger, MD, of UCSD School of Medicine, discusses the use of V/Q scanning and right heart catheterization in diagnosing chronic thromboembolic pulmonary hypertension, or CTEPH.
    Click to Play Video

  • Paul Forfia, MD, of Temple University Hospital, Philadelphia, discusses how venous thromboembolism can be a potential precursor to CTEPH.

    Paul Forfia, MD, of Temple University Hospital, Philadelphia, discusses how venous thromboembolism can be a potential precursor to CTEPH.
    Click to Play Video

  • Richard Channick, MD, of Massachusetts General Hospital reviews pulmonary thromboendarterectomy—which is commonly known as PTE or PEA—the only potentially curative treatment for CTEPH.

    Richard Channick, MD, of Massachusetts General Hospital reviews pulmonary thromboendarterectomy—which is commonly known as PTE or PEA—the only potentially curative treatment for CTEPH.
    Click to Play Video

  • Raymond L. Benza, MD, of Allegheny Health Network, Pittsburgh, reviews the respective roles of ventilation/perfusion scans and computed tomographic pulmonary angiography in CTEPH.

    Raymond L. Benza, MD, of Allegheny Health Network, Pittsburgh, reviews the respective roles of ventilation/perfusion scans and computed tomographic pulmonary angiography in CTEPH.
    Click to Play Video

  • In this video, Dr Michael Madani, of the PTE Program at UCSD, shows key steps—including extraction of thromboembolic material—in performing PTE surgery (also known as PEA).

    In this video, Dr Michael Madani, of the PTE Program at UCSD, shows key steps—including extraction of thromboembolic material—in performing PTE surgery (also known as PEA).
    Click to Play Video

  • Dr Bill Auger of the PTE Program at UCSD reviews important considerations in evaluating CTEPH patients’ eligibility for potentially curative PTE surgery (also known as PEA).

    Dr Bill Auger of the PTE Program at UCSD reviews important considerations in evaluating CTEPH patients’ eligibility for potentially curative PTE surgery (also known as PEA).
    Click to Play Video

  • Ivan Robbins, MD, of Vanderbilt University Medical Center, Nashville, presents a case illustrating the importance of the ventilation/perfusion scan as a screen for CTEPH.

    Ivan Robbins, MD, of Vanderbilt University Medical Center, Nashville, presents a case illustrating the importance of the ventilation/perfusion scan as a screen for CTEPH.
    Click to Play Video

  • CTEPH Basics

    Nick H. Kim, MD, of UCSD School of Medicine, provides a background understanding of chronic thromboembolic pulmonary hypertension, or CTEPH, including epidemiology, risk factors, and symptoms.
    Click to Play Video

  • The Pathophysiology of CTEPH

    Victor F. Tapson, MD, of Cedars-Sinai Medical Center, Los Angeles, looks at how CTEPH develops, how it manifests, and several important considerations in distinguishing CTEPH from PAH.
    Click to Play Video

  • Differential Diagnosis of CTEPH

    Raymond L. Benza, MD, of Allegheny General Hospital, Pittsburgh, works through the differential diagnosis of CTEPH, outlining diagnostic difficulties and a helpful mnemonic device to guide clinicians.
    Click to Play Video

  • V/Q Scanning and RHC in CTEPH

    William R. Auger, MD, of UCSD School of Medicine, discusses the use of V/Q scanning and right heart catheterization in diagnosing chronic thromboembolic pulmonary hypertension, or CTEPH.
    Click to Play Video

  • Potential Precursors to CTEPH

    Paul Forfia, MD, of Temple University Hospital, Philadelphia, discusses how venous thromboembolism can be a potential precursor to CTEPH.
    Click to Play Video

  • PTE/PEA Surgery

    Richard Channick, MD, of Massachusetts General Hospital reviews pulmonary thromboendarterectomy—which is commonly known as PTE or PEA—the only potentially curative treatment for CTEPH.
    Click to Play Video

  • V/Q scan versus CTPA

    Raymond L. Benza, MD, of Allegheny Health Network, Pittsburgh, reviews the respective roles of ventilation/perfusion scans and computed tomographic pulmonary angiography in CTEPH.
    Click to Play Video

  • Key Steps in Performing PTE Surgery

    In this video, Dr Michael Madani, of the PTE Program at UCSD, shows key steps—including extraction of thromboembolic material—in performing PTE surgery (also known as PEA).
    Click to Play Video

  • Important Operability Assessment Considerations

    Dr Bill Auger of the PTE Program at UCSD reviews important considerations in evaluating CTEPH patients’ eligibility for potentially curative PTE surgery (also known as PEA).
    Click to Play Video

  • Reassessing a Misdiagnosis

    Ivan Robbins, MD, of Vanderbilt University Medical Center, Nashville, presents a case illustrating the importance of the ventilation/perfusion scan as a screen for CTEPH.
    Click to Play Video

A form of pulmonary hypertension designated by the World Health Organization as group 4, CTEPH occurs when there is an unresolved clot, resulting in the formation of scar tissue that partially or completely block the pulmonary arteries.

While the correct diagnosis for this is CTEPH, it is often mistakenly referred to as "chronic clot" or "chronic PE".

After an acute PE, 1 in 25 patients whose symptoms persist following 3 months of anticoagulation, may develop CTEPH.

To differentiate between acute PE and CTEPH, three diagnostic tools are necessary RHC, CTPA, and a V/Q scan.

RHC, the first step, verifies a diagnosis of PH and tests hemodynamics of CTEPH, which is a mean pulmonary arterial pressure greater than or equal to 25 mm Hg, with a pulmonary capillary wedge pressure less than or equal to 15 mm Hg.

CTPA is highly specific for acute PE, but the screening test for CTEPH only has a reliability of 51%.

If you question whether a patient has CTEPH, a V/Q scan can help you discover the answer.

A V/Q scan is the preferred and recommended test for CTEPH, with a screening sensitivity greater than 96%.

While challenging, differentiating between acute PE and CTEPH is critical for patients, and recognizing that PE can lead to CTEPH is a vital consideration in this assessment.