Utility of computed tomography in differentiation between different groups of pulmonary hypertension in SLE patients

Pulmonary hypertension (PH) is a serious and potentially life-threatening complication of systemic lupus erythematosus (SLE). Its etiology in SLE is heterogeneous and includes vasculopathy, interstitial lung disease (ILD), left-sided heart dysfunction, and chronic thromboembolic disease. High-resolution computed tomography (HRCT) plays an important role in defining phenotypes and supporting targeted management. This analytical cross-sectional study included 60 adults with SLE and echocardiograph-confirmed PH. All patients underwent clinical evaluation and HRCT. Radiologic patterns were evaluated and correlated with pulmonary hypertension subtypes based on the 2022 ESC/ERS classification. We used SPSS v20 to analyze the data, and chi-square and Fisher’s exact tests were used to look for connections. In our cohort of patients with SLE and confirmed pulmonary hypertension, the most prevalent subtype observed was Group 2 PH, attributed to underlying left-sided heart disease (48.3%). This was followed by pulmonary arterial hypertension (25%), PH due to lung disease/hypoxia (20%), and chronic thromboembolic PH (6.7%). HRCT findings differed significantly among PH groups using Fisher’s Exact Test (p < 0.05). Normal HRCT scans were most frequent in Group 1, lung congestion with septal thickening predominated in Group 2 (p = 0.049), nonspecific interstitial pneumonia (NSIP)—a pattern of interstitial lung disease—was strongly associated with Group 3 (p < 0.000001), and all Group 4 patients demonstrated pulmonary embolism on Computed Tomography Pulmonary Angiography (CTPA) (p < 0.00001). HRCT patterns vary markedly across PH subtypes in SLE and provide important diagnostic clues to the underlying pathophysiological mechanism. HRCT provides important phenotypic information that supports noninvasive classification of SLE-associated pulmonary hypertension and helps guide further diagnostic and management pathways.