Interesting Images 2

A 57 year –old- woman presented with recent exacerbation of dyspnea on exertion, New York Heart Association (NYHA) functional class III-IV. Physical examination revealed arterial O2 desaturation about 85% at room air associated with Ascites and peripheral edema. Transthoracic echocardiography showed significant pulmonary arterial hypertension about 85 mmHg besides normal LV systolic function (EF=55%) . Right heart catheterization was done and hemodynamic study showed PAP=80/35 mmHg, PCWP=12 mmHg. Cardiovascular CT images are as the following.