7, Radiologic Clinics of North America, Vol. A peripheral intraluminal filling defect that forms acute angles with the arterial wall (,Fig 7) (,15–,17). Ancillary findings in chronic pulmonary embolism may include CT changes caused by pulmonary arterial hypertension: a pulmonary artery diameter greater than 33 mm (,Fig 18) (,23) and pericardial fluid (,Fig 19) (,24). In 17 patients with central pulmonary embolism, the raw data were used to perform reconstructions with 1-mm, 2-mm, and 3-mm section thicknesses. Figure 10a. 3, 5 December 2015 | European Radiology, Vol. 24, No. 10, 1 October 2014 | Acta Radiologica, Vol. (a) CT scan shows poor enhancement of the interlobar and middle lobe pulmonary arteries due to flow-related artifact. Noninspiratory imaging important to avoid transient attenuation artifact, due to contrast dilution from mixing of IVC blood if patient Valsalvas. For low dose 70 and 80 kVp protocols, SNR was significantly lower in the high-pitch of 3.2 protocols than that in other protocols with different pitch values (P Conclusions: Low-dose CT pulmonary angiography can be achieved with use of low kVp (80 and 100) and high-pitch protocol with significant reduction in radiation dose while maintaining diagnostic images of PE. Tumor embolus in a 78-year-old woman with dyspnea and endometrial stromal sarcoma that invaded the inferior vena cava. (e) More oblique angiogram of the left pulmonary artery also demonstrates no evidence of pulmonary embolism (arrow).Download as PowerPointOpen in Image
Figure 4. These artifacts are best seen with lung window settings and can create the “seagull” sign (,,,Fig 20a). Figure 17. 55, No. 31, No. Figure 28c. 5, Korean Journal of Radiology, Vol. Partial volume artifact in a 52-year-old woman with dyspnea. Small pulmonary emboli are noted in the left pulmonary artery. 4, The American Journal of Emergency Medicine, Vol. Pulmonary embolism can be difficult to diagnose, especially in people who have underlying heart or lung disease. 6, 10 October 2018 | Journal of Medical Imaging and Radiation Oncology, Vol. When a rapid diagnosis of pulmonary embolism is essential for patients with chronic pulmonary hypertension possibly secondary to central embolism, particularly patients being considered for pulmonary thromboendarterectomy. (b) Contiguous CT scan obtained inferior to a demonstrates normal lung adjacent to the left upper lobe pulmonary artery. Flow-related artifact in a 73-year-old woman with chest pain. Figure 10b. CT scan shows the vascular bifurcation between the left lower lobe and lingular arteries as a curved line surrounded by contrast material (arrow). Figure 25c. Edema caused by raised left atrial pressure can produce peribronchovascular interstitial thickening, which mimics chronic pulmonary embolism at CT pulmonary angiography. No embolism was present. (a) CT scan shows a flow artifact caused by a localized increase in vascular resistance (arrow), a finding that can mimic acute pulmonary embolism. However, contiguous images will not demonstrate more apparent filling defects, and the margins are often not sharp. Figure 33. 5, The Egyptian Journal of Radiology and Nuclear Medicine, Vol. Partial volume artifact in a 52-year-old woman with dyspnea. Figure 12. Accurate and reliable diagnosis of acute pulmonary embolism (PE) is crucial to enable rapid treatment and guide patient management . (b) CT scan shows acute emboli that affect subsegmental arteries of the laterobasal segment (arrows).Download as PowerPointOpen in Image
The lung algorithm is a high-spatial-frequency reconstruction convolution kernel used to improve the quality of images of the pulmonary vessels, bronchi, and interstitium. Figure 24b. To compare intravenous contrast material (CM) injection protocols for dual-energy CT pulmonary angiography (CTPA) in patients with suspected acute pulmonary embolism with regard to image quality and pulmonary perfused blood volume (PBV) values. Figure 24a. Note also the medium-sized left pleural effusion and atelectasis. Chronic pulmonary embolism in the same patient as in ,Figure 11. Note also the medium-sized left pleural effusion and atelectasis. MR pulmonary angiography: Can it be used as an alternative for CT angiography in diagnosis of major pulmonary thrombosis? 2, 14 January 2016 | Iranian Journal of Radiology, Vol. 48, No. Figure 5a. Multisection CT venography is simple and accurate, and when combined with lung imaging it allows fast and comprehensive evaluation for thromboembolic disease (,14). 43, No. Acute pulmonary embolism in a 58-year-old woman who presented with chest pain and dyspnea. (c) Contiguous CT scan obtained immediately superior to a demonstrates a contrast material-filled pulmonary artery, a finding that confirms that the low attenuation seen in a was due to partial volume artifact. Graph illustrates that the number of CT studies performed for pulmonary embolism per inpatient increased significantly between 1992 and 2001 (P = .006). Acute pulmonary embolism in a 45-year-old woman who presented with chest pain. (a) On a CT scan, a pulmonary artery catheter causes adjacent beam-hardening artifacts within the main and right pulmonary arteries that mimic pulmonary embolism (arrows). 188, No. When used in conjunction with validated clinical decision tools like modified Wells criteria, CT-angiography is highly sensitive (good at detecting PE when it's there and ruling it out when it's not) and specific (generating few false-positive results). Figure 34a. Figure 10a. 2, Annals of Thoracic and Cardiovascular Surgery, Vol. Viewer. For that reason, your doctor will likely order one or more of the following tests. 6, American Journal of Roentgenology, Vol. Each radiology department will have a slightly different method for achieving the same outcome, i.e. Partial filling defects due to acute pulmonary embolism are often centrally located, but when eccentrically located they form acute angles with the vessel wall. Figure 30c. However, further imaging may be necessary to exclude thrombus hidden in poorly enhanced vessels (,,,Fig 24). Beam-hardening artifact in a 63-year-old man with respiratory failure. (a) CT scan shows peribronchovascular interstitial thickening caused by perivascular edema (arrow), a finding that can mimic chronic pulmonary embolism. Figure 20a. 1, Seminars in Ultrasound, CT and MRI, Vol. CT scan shows a large tumor embolus within the right lower lobe pulmonary artery (arrow).Download as PowerPointOpen in Image
Figure 17. This pathologic condition, whether acute or chronic, causes both partial and complete intraluminal filling defects, which should have a sharp interface with intravascular contrast material. (b) Confirmatory CT pulmonary angiogram demonstrates acute pulmonary embolism within the right main and left interlobar pulmonary arteries.Download as PowerPointOpen in Image
Viewer, Radiologist Performance in the Detection of Pulmonary Embolism, Seagull sign: Respiratory motion artefact, Dual-Energy CT Pulmonary Angiography: Quantification of Disease Burden and Impact on Management, Imaging of urgencies and emergencies in the lung cancer patient, Incidental pulmonary emboli in stage IV melanoma patients: Prevalence in CT staging examinations and improved detection with vessel reconstructions based on dual energy CT, Pulmonary thromboembolism: new diagnostic imaging techniques, Pitfalls in the Diagnosis of Acute Pulmonary Embolism on Computed Tomography: Common Pathologic and Imaging Mimics, Imaging of Nontraumatic Mediastinal and Pulmonary Processes, Clot or Not? 21, No. Figure 20b. 29, No. Graph illustrates that the number of ventilation-perfusion scans performed per inpatient with suspected thromboembolic disease decreased significantly between 1992 and 2001 (P = .0003). Contrasted CT-angiography of the chest, often called a "PE protocol CT," has dramatically improved the diagnosis of pulmonary embolism. Pulmonary arterial hypertension secondary to chronic pulmonary embolism in the same patient as in ,Figure 12. The computed tomography pulmonary angiogram (CTPA/CTPE) is a commonly performed diagnostic examination to exclude pulmonary emboli. Figure 30d. Acute central pulmonary embolism in an asymptomatic 87-year-old woman. For those with one or more items on the modified YEARS protocol, pulmonary embolism can be excluded if the D-dimer test shows a level less than 500 ng/mL. 12, No. Left-sided heart failure in a 56-year-old woman with dyspnea. CT scan shows a large chronic pulmonary embolus in the main and left main pulmonary arteries (arrowhead). The apparent pulmonary embolism is ill defined. (b) CT scan produced with bone window settings clearly depicts the pulmonary artery catheter. (a) CT scan shows a flow artifact caused by a localized increase in vascular resistance (arrow), a finding that can mimic acute pulmonary embolism. (b) Contiguous CT scan obtained inferior to a demonstrates normal lung adjacent to the left upper lobe pulmonary artery. Lung algorithm artifact in a 70-year-old woman with dyspnea. CT scan shows pulmonary arterial wall calcification (arrows), a secondary sign of chronic pulmonary embolism.Download as PowerPointOpen in Image
Ju Hee Yeo, Lifeng Zhou, Remy Lim. The apparent pulmonary embolism is ill defined. Discuss the causes of indeterminate CT pulmonary angiography. 3, 11 March 2017 | Academic Emergency Medicine, Vol. Right ventricular strain or failure is optimally monitored with echocardiography. (a) Unenhanced CT scan demonstrates subtle regions of hyperattenuation (arrow). Because the signs and symptoms are inconsistent, the diagnosis is often missed. Three protocols followed the above CM injection, protocol-1 (P-1) with immediate exposure, protocol-2 (P-2) with exposure after 10 sec.-delayed, and protocol-3 (P-3) with exposure after injection of 30ml saline (3ml/sec. CT scan shows tumor emboli with a tree-in-bud appearance within secondary pulmonary lobule arterioles (arrow). Note the collateral blood supply from a branch of the right hemidiaphragmatic artery (arrow). allergy) and time constraints. We use pulmonary embolism–specific settings with a window width and level of 700 and 100 HU, respectively (,,,,Fig 25c). Mucus plugs in an 83-year-old woman with dyspnea. Figure 18. Chronic pulmonary embolism in a 56-year-old man with dyspnea. CT scan shows streak artifact from dense contrast material within the superior vena cava (arrows). (b) CT scan (lung window) demonstrates the accompanying findings of diffuse peribronchovascular thickening, ground-glass attenuation, smooth interlobular septal thickening (arrows), and bilateral pleural effusions. Viewer. 10, European Journal of Radiology, Vol. CT scan shows an acute pulmonary embolus with ancillary findings of a peripheral wedge-shaped area of hyperattenuation in the lung (arrow), a finding that may represent an infarct, as well as a linear band (arrowhead). Enter your email address below and we will send you the reset instructions. Figure 35a. Partial volume artifact in a 52-year-old woman with dyspnea. 3, Journal of Thoracic Oncology, Vol. Figure 5b. Figure 30b. Viewer. Note also the fluid-filled, dilated esophagus. 26, No. 4, European Journal of Radiology, Vol. Note also the medium-sized left pleural effusion and atelectasis. CT scans demonstrate normal hilar lymph nodes in both upper lobes (arrows in a), adjacent to the right and left interlobar arteries (arrows in b), in the middle lobe and lingula (arrows in c), and in both lower lobes (arrows in d).Download as PowerPointOpen in Image
Viewer. 16, No. Acute occlusive pulmonary embolism in a 32-year-old woman who presented with chest pain. Viewer. More distally, the pulmonary arteries were well enhanced. Contrast material–enhanced spiral CT of the veins of the lower extremities is performed with the same contrast material bolus that is used for chest CT. 44, No. 116, No. The dark regions of underperfused lung are seen to contain vessels (arrows) that are smaller than the adjacent patent vessels in the normally perfused lung.Download as PowerPointOpen in Image
5, 1 January 2015 | Polish Journal of Radiology, Vol. CT scans demonstrate normal hilar lymph nodes in both upper lobes (arrows in a), adjacent to the right and left interlobar arteries (arrows in b), in the middle lobe and lingula (arrows in c), and in both lower lobes (arrows in d). Use high concentration ≥350 mgI/mL for larger patients (higher enhancement). 191, No. 92, No. This approach helps differentiate between a sharply marginated embolus and an ill-defined artifact. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. (2010) Radiology. The posterobasal segment of the right lower lobe bronchus is dilated as well as mucus filled. 3, Radiologic Clinics of North America, Vol. Figure 25a. Figure 35b. A widely accepted formula for calculating the scan delay is, peak contrast enhancement (time-enhancement curve) + scanner's diagnostic scan delay, what constitutes as a diagnostic CTPA based on enhancement varies from site-to-site, changing the scan direction to caudocranial has been shown to better demonstrate the lower lobes whilst alleviating artefact from the contrast bolus in the SVC, use of high-pitch-scanning in non-obese patients can see a reduction in contrast use to as low as 12ml. 93, No. (a) On a CT scan, a pulmonary artery catheter causes adjacent beam-hardening artifacts within the main and right pulmonary arteries that mimic pulmonary embolism (arrows). CT scan demonstrates a pulmonary embolus that results in an eccentrically positioned partial filling defect, which is surrounded by contrast material and forms acute angles with the arterial wall (arrows). Acute pulmonary embolism in a 59-year-old man. Acute pulmonary embolism in a 66-year-old man who presented with chest pain and dyspnea. Viewer. However, this pitfall can be recognized by observing veins on contiguous images to the level of the right atrium.Download as PowerPointOpen in Image
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