Despite the comprehensive, evidence-based guidance offered by current international guidelines on the management of pulmonary hypertension, clinicians frequently encounter situations where the correct diagnosis or the most appropriate treatment remains uncertain.
Methods
A panel of pulmonary hypertension experts identified ten real-world diagnostic and management dilemmas during 2024–2025. For each, the available evidence was reviewed and a practical approach proposed.
Results
The dilemmas covered include pulmonary hypertension presenting with high cardiac output, idiopathic pulmonary arterial hypertension in patients with cardiopulmonary comorbidities, pulmonary hypertension linked to left heart disease, pulmonary hypertension in the context of obesity, conditions that mimic chronic thromboembolic pulmonary hypertension, and Group 5 pulmonary hypertension associated with sarcoidosis, fibrosing mediastinitis, and neurofibromatosis type 1.
Conclusions
The approaches proposed draw on a thorough review of existing evidence and guidelines, complemented by the clinical experience of the expert panel.
Citation
Diagnostic and management dilemmas in pulmonary hypertension, Robin Condliffe, Jurjan Aman, Athénaïs Boucly, European Respiratory Review 2026 35(180): 250337; DOI: https://doi.org/10.1183/16000617.0337-2025
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