On a contrast-enhanced chest CT of a patient with long-standing pulmonary arterial hypertension, the central pulmonary arteries are markedly enlarged while the peripheral subsegmental vessels show abrupt tapering. What is this characteristic vascular appearance called?
- A Mosaic attenuation with mosaic perfusion
- B Tree-in-bud pattern
- C Pruning of peripheral pulmonary vessels ✓
- D Signet ring sign
Correct answer: C. Pruning of peripheral pulmonary vessels
Explanation
In pulmonary arterial hypertension, sustained high pressure causes central pulmonary artery dilation with progressive rarefaction and abrupt tapering of distal branches, described as pruning. Tree-in-bud indicates small airway impaction, and the signet ring sign indicates bronchiectasis with an accompanying pulmonary artery, so both are structurally unrelated to this finding.
Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.
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