Date post: | 07-May-2015 |
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Thrombotic and Nonthrombotic
Pulmonary Arterial Embolism
By
Gamal Rabie Agmy , MD , FCCP Professor of Chest Diseases ,Assiut University
Acute Pulmonary Embolism Saddle PE :that lodges at the bifurcation of the main
pulmonary artery
Multidetector-CT
Findings
• Partial or complete filling defects in lumen of pulmonary arteries – Most reliable sign is filling defect forming acute
angle with vessel wall with defect outlined by contrast material
– “Tram-track sign” • Parallel lines of contrast surrounding thrombus in vessel
that travels in transverse plane
– “Rim sign” • Contrast surrounding thrombus in vessel that travels
orthogonal to transverse plane
• RV strain indicated by straightening or leftward bowing of interventricular septum
Macdonald S; Mayo J. Semin. Ultrasound CT. 2003;24(4):271-231.
Large saddle thrombus with extensive clot burden. Arrows
demonstrating tram-track sign (A), rim sign (B), complete
filling defect (C), and a fully non-contrasted vessel (D)
Acute pulmonary embolism and deep venous thrombosis (DVT) in a 48-year-old woman. (a) Contrast
material–enhanced pulmonary CT arteriogram (1.25-mm collimation) obtained at the level of the basal
subsegmental pulmonary artery shows multifocal low-attenuation emboli (arrows) in segmental and
subsegmental arteries in the right lower lobe. (b) Contrast-enhanced indirect CT venogram (5-mm
collimation) obtained at the level of the pelvic inlet 3 minutes after injection shows large low-
attenuation thrombi filling the left common iliac vein (arrow).
Acute pulmonary embolism in a 41-yearoldwoman. Coronal gadolinium-
enhanced three-dimensional pulmonary MR angiogram shows a large embolus
(arrows) in the proximal right interlobar artery.
Embolic burden scoring system. Schematic of the pulmonary
arterial tree with scores for nonocclusive emboli according to
vessel. Emboli in a segmental pulmonary artery are given a score
of 1. Emboli in more proximal pulmonary arteries are given a
score based on the total number of segmental pulmonary arteries
supplied.
Helical CT Findings in Chronic PTE
Cardiac abnormalities Right ventricular enlargement
Right atrial enlargement
Thrombi in the right atrium or ventricle*
Vascular abnormalities Eccentric, flattened defect at an obtuse angle with
the vessel wall*
Irregular or nodular arterial wall
Abrupt narrowing of the vessel diameter
Abrupt cutoff of distal lobar or segmental artery
Recanalization of thrombosed vessel
Webs or bands (less frequent)
Parenchymal abnormalities Bronchial artery dilatation
Bronchiectasis
Areas of decreased attenuation in the lung (mosaic
perfusion pattern)
Septic Pulmonary Embolism Septic pulmonary embolism in a 28-year-old intravenous drug abuser with human
immunodeficiency viral infection. Repeated blood cultures disclosed a positive culture
for Nocardia. (a) Radiograph shows multiple cavitary nodules throughout both lungs.
(b) CT scan (10-mm collimation) obtained at the level of the azygos arch
demonstrates the feeding vessel sign (vessel leading directly to the nodule) in several
nodules
Hydatid Embolism
Fat Embolism
Amniotic Fluid Embolism
Tumor Embolism
Air Embolism
Talc Embolism
Cement (Polymethylmethacrylate) Embolism
Iodinated oil embolism
Miscellaneous Foreign Body Embolism