Eisenmenger Syndrome

  • Etiology: long standing large left to right shunt causing irreversible pulmonary hypertension: initially acyanotic with a left to right shunt, pulmonary arteries thicken and develop pulmonary hypertension, pulmonary pressure becomes greater than systemic pressure, shunt reverses to right to left shunt, deoxygenated right heart blood shunts to systemic circulation, cyanosis results
  • CXR: Prominent central pulmonary artery with periperal pruning of pulmonary blood flow
  • Clinical: acyanotic to cyanotic, most commonly caused by ventricular septal defect and less commonly by atrial septal defect and patent ductus arteriosus

Eisenmenger Syndrome

CXR of Eisenmenger syndrome due to ventricular septal defect / VSD
CXR AP at 4 years of age (above) shows mild prominence of the pulmonary arteries bilaterally. CXR AP at 24 years of age (below) shows marked enlargement of the pulmonary arteries bilaterally with peripheral pruning of the pulmonary vasculature.
CXR and CT of septic emboli in the lungs / septic pulmonary emboli
CXR AP (above) shows multiple round lesions of varying size throughout both lungs which on the axial CT with contrast of the chest (below) are shown to have indistinct margins.