Ultrasound-Based assessment of systemic congestion in pulmonary hypertension

Systemic congestion is a common manifestation in pulmonary hypertension (PH) associated with morbidity and mortality. Its extent can be difficult to define and is usually determined by subjective medical history and physical examinations, leading to delay in decision-making. We conducted a literature review to collect evidence on imaging tools aimed at detecting and defining severity of venous congestion in PH.

We discussed pathophysiology and outlined a structured approach in the management of venous congestion. Point-of-care ultrasound becomes more accessible and aids in gauging the severity of systemic congestion. Venous excess ultrasound (VExUS) grading system analyzes the inferior vena cava, hepatic vein, portal vein, and intrarenal vein and provides a comprehensive assessment of systemic congestion. Nonetheless, almost all available studies were performed in unselected populations, and data on PH is scarce. Herein, we discuss the imaging methods proposed in systemic congestion as they apply to PH.

VExUS offers fast, convenient assessment of volume status. Despite the promising data on VExUS, it should be emphasized that ultrasound should be placed in the context of a comprehensive evaluation and should not replace basic examination. Further research is needed to establish its role in PH and verify its clinical utility in guiding fluid management.