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Abstract

We thank Drs Maslonka and Miles for their comments regarding the egg-and-banana sign. We agree with their general remarks regarding the usefulness of noninvasive measures to help pulmonologists and radiologists depict features suggestive of pulmonary hypertension (PH). When patient’s symptoms may be related to PH, physicians usually establish a pre-CT scan likelihood of PH based on symptoms and the pulmonary function test profile, and the potential role of CT scan is to contribute to the working diagnosis of PH. In this stepwise approach of PH likelihood, the observed enlargement of the pulmonary trunk is very likely to indicate the presence of PH, whereas one should not forget that a normal pulmonary artery diameter does not rule out the diagnosis of PH. In the context of PH, pulmonary trunk enlargement is not an isolated finding; CT scan depicts enlarged central pulmonary arteries (namely the pulmonary trunk, main right and left side pulmonary arteries, and right and left side interlobar pulmonary arteries) and enlarged lobar and peripheral divisions. The overall dilatation of the pulmonary arterial tree is an important clue for PH and we do not think that the isolated finding of the elevated main pulmonary artery to the level of the aortic arch (ie, egg-and-banana sign) represents a major contribution to the depiction of PH based on morphologic findings. From a practical standpoint, this sign may alert the radiologist at the time of CT scan interpretation but the presence of PH will never be suggested based on this single CT scan feature. The complexity of PH requires analysis of all morphologic information, not only to suggest the hemodynamic syndrome, but also to participate in the search of the etiology of PH. Moreover, radiologic descriptions currently favor the use of anatomic descriptors because high-spatial and high-resolution CT examinations offer a unique possibility to approach fine abnormalities at the level of thoracic organs.1Altschul E. Remy-Jardin M. Machnicki S. et al.Imaging of pulmonary hypertension: pictorial essay.Chest. 2019; 156: 211-227Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar In such a context, there is not much enthusiasm for switching to culinary terms. Imaging of Pulmonary Hypertension: Pictorial EssayCHESTVol. 156Issue 2PreviewPulmonary hypertension (PH) is an end result of a diverse array of complex clinical conditions that invoke hemodynamic and pathophysiological changes in the pulmonary vasculature. Many patients’ symptoms begin with dyspnea on exertion for which screening tests such as chest roentgenograms and more definitive noninvasive tests such as CT scans are ordered initially. It is imperative that clinicians are cognizant of subtle clues on these imaging modalities that alert them to the possibility of PH. Full-Text PDF Pulmonary Hypertension, Eggs, and BananasCHESTVol. 157Issue 5PreviewWe read with interest the excellent pictorial essay in the August 2019 issue of CHEST.1 In addition to the explained findings, we would also like to highlight the described egg-and-banana sign. Along with other CT scan markers suggestive of pulmonary hypertension (PH), this specific finding may lead to an earlier diagnosis and potentially better outcomes for patients who would have otherwise been delayed in treatment, therefore limiting their morbidity and mortality. Together with the described radiographic findings, this noninvasive measure will assist providers in pursuing further studies and help guide appropriate therapy. Full-Text PDF