Chronic thromboemboli pulmonary hypertension (CTEPH) is the group 4 of pulmonary hypertension, related to clot blocking in the pulmonary arteries in lungs. Patients with CTEPH have varies typical or atypical symptoms, which are not specific. So the diagnosis of CTEPH is a challenge to clinicians [1,2]. Chronic thromboembolic pulmonary hypertension (CTEPH) most often results from obstruction of the pulmonary vascular bed by non-resolving thromboemboli. Chronic thromboembolic pulmonary hypertension can arise in patients after acute or recurrent pulmonary emboli or deep venous thrombosis. The incidence of CTEPH is not known, but recent studies suggest that 1% to 3.8% of patients develop the condition within 2 years of acute pulmonary embolism . 64-row CT of the pulmonary arteries can yield diagnostically excellent image quality and can delineate the typical angiographic findings in CTEPH such as complete obstruction, bands and webs and intimal irregularities as accurate and reliable as DSA. With additional thick MIPs it is possible to get an instant overview of the entire pulmonary arterial tree, which helps to demonstrate the pathology related of CTEPH similar to DSA  when the diagnosis of CTEPH is confirmed, anticoagulant should be used. Pulmonary thromboendarectomy is the most optimal therapeutic beside Pulmonary artery Balloon dilation. We found a rare case diagnosed CTEPH with Eisenmenger syndrome, large PDA by CT scanner and Echocardiography.
Ke Toan Tran, Le Tra Pham* , Luan Ha Quang