36, No. 3, Journal of Small Animal Practice, Vol. However, when this artifact is due to cardiac or respiratory motion, overlapping reconstruction will not completely eradicate it. 10, 11 April 2018 | Insights into Imaging, Vol. (2019) Journal of medical imaging and radiation sciences. 36, No. 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). ), Figure 4. Collateral bronchial artery dilatation is also noted (arrowhead).Download as PowerPointOpen in Image 1104, Current Pulmonology Reports, Vol. Graph illustrates that the number of pulmonary angiographic studies performed per inpatient with suspected thromboembolic disease decreased significantly between 1992 and 2001 (P = .02). Murphy A, Cheng J, Pratap J, Redman R, Coucher J. Dual-Energy Computed Tomography Pulmonary Angiography: Comparison of Vessel Enhancement between Linear Blended and Virtual Monoenergetic Reconstruction Techniques. (e) More oblique angiogram of the left pulmonary artery also demonstrates no evidence of pulmonary embolism (arrow). Viewer. Acute pulmonary embolism in a 45-year-old woman who presented with chest pain. (a) CT scan shows a flow artifact caused by a localized increase in vascular resistance (arrow), a finding that can mimic acute pulmonary embolism. Pulmonary CT angiography (CTA) has been firmly established as the modality of choice in suspected acute PE [2, 3]. 52, No. More distally, the pulmonary arteries were well enhanced. Good quality CT scanning is the most important factor for the diagnosis of pulmonary emboli. Respiratory motion artifact in a 61-year-old man with dyspnea. CT scan shows a flap (arrow) within a small right interlobar pulmonary artery. CT scan demonstrates pulmonary artery stump in situ thrombosis that affects the right pulmonary artery (arrow). 10, 1 October 2014 | Acta Radiologica, Vol. On a poor quality scan it is impossible to rule out emboli. Note also the medium-sized left pleural effusion and atelectasis. Chronic pulmonary embolism in the same patient as in ,Figure 11. (a) CT scan shows a flow artifact caused by a localized increase in vascular resistance (arrow), a finding that can mimic acute pulmonary embolism. Transient interruption of contrast enhancement is likely related to inspiration and to unenhanced blood entering the right atrium, right ventricle, and pulmonary arteries from the inferior vena cava just prior to image acquisition (,27). 2, 22 September 2015 | Journal of Magnetic Resonance Imaging, Vol. 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. However, these artifacts can be removed with a standard algorithm (,,,Fig 27) (,30). 5, Korean Journal of Radiology, Vol. Computed tomographic pulmonary angiography (CTPA) has become the standard of care for the evaluation of patients with suspected pulmonary embolism (PE) in most institutions. A flow-related artifact can be confidently diagnosed by identifying its ill-defined margins and by demonstrating an attenuation level above 78 HU (,28). Stair step artifact in an 84-year-old man with dyspnea and chest pain. 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. 245, No. (a) CT scan shows a flow artifact caused by a localized increase in vascular resistance (arrow), a finding that can mimic acute pulmonary embolism. 9, The Journal of Emergency Medicine, Vol. Indeterminate CT pulmonary angiogram: Why and does it matter?. (a) CT scan (lung window) shows composite images of vessels (seagull sign) (arrows). Note also the medium-sized left pleural effusion and atelectasis. Pulmonary embolism positivity rate was non-significantly higher in the timing bolus vs the empiric timing group (19% and 13%, P=0.1). 57, No. CT Findings of Disease with Elevated Serum D-Dimer Levels in an Emergency Room Setting, Prospective Evaluation of Unsuspected Pulmonary Embolism on Coronary Computed Tomographic Angiography, Pulmonary Embolic Disease and Cardiac Tumors, Pulmonary MDCT Angiography: Value of Multiplanar Reformatted Images in Detecting Pulmonary Embolism in Children, A Multistage Approach to Improve Performance of Computer-Aided Detection of Pulmonary Embolisms Depicted on CT Images: Preliminary Investigation, Urgent Findings on Portable Chest Radiography: What the Radiologist Should Know— 31, No. Viewer. Enter your email address below and we will send you the reset instructions. They may demonstrate vascular distention and local extravascular spread (,40). 61, No. (c) CT scan (window width = 700 HU, window level = 100 HU) demonstrates thrombus within the right interlobar artery and the medial segment of the middle lobe artery. Esophagitis and, rarely, esophageal rupture may also be identified, as well as pneumonia, lung cancer, and pleural disease, including pneumothorax and pleuritis. 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). Viewer. 3, Clinics in Chest Medicine, Vol. CT scan shows pulmonary arterial wall calcification (arrows), a secondary sign of chronic pulmonary embolism. (a) On a 3.75-mm-thick CT scan, partial volume averaging of vessel and lung creates an artifact that mimics pulmonary embolism within the anterior segment of the left upper lobe pulmonary artery (arrow). CT pulmonary angiogram is a medical diagnostic test that employs computed tomography angiography to obtain an image of the pulmonary arteries. (d) Subsequent angiogram demonstrates slight distortion of the posterobasal segment of the left lower lobe pulmonary artery (arrow) but no evidence of pulmonary embolism. Viewer. 1, Archivos de Bronconeumología (English Edition), Vol. Figure 18. Viewer. (d) Subsequent angiogram demonstrates slight distortion of the posterobasal segment of the left lower lobe pulmonary artery (arrow) but no evidence of pulmonary embolism. These findings indicate the true nature of the patient’s condition.Download as PowerPointOpen in Image The current standard of care for members with suspected pulmonary embolism is a spiral CT scan, also called a CTA, CT PA (computed tomography pulmonary angiography), MDCT (multidector CT) or helical CT scan. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. Note also the medium-sized left pleural effusion and atelectasis. (e) More oblique angiogram of the left pulmonary artery also demonstrates no evidence of pulmonary embolism (arrow).Download as PowerPointOpen in Image Figure 34b. Viewer. (a) Unenhanced CT scan demonstrates subtle regions of hyperattenuation (arrow). These artifacts are best seen with lung window settings and can create the “seagull” sign (,,,Fig 20a). Acute PE is the third most common acute cardiovascular disease after myocardial infarction and stroke, and results in many deaths each year. Viewer. A pulmonary artery catheter that is being used for invasive hemodynamic monitoring of critically ill patients can cause beam-hardening artifacts or may itself mimic pulmonary embolism (,,,Fig 22) (,26). Figure 35c. 116, No. Figure 24a. 205, No. Figure 11. (a) CT scan shows a flow artifact caused by a localized increase in vascular resistance (arrow), a finding that can mimic acute pulmonary embolism. 199, No. Both acute and chronic pulmonary embolism cause intraluminal filling defects that should have a sharp interface with the intravascular contrast material. 118, No. Acute pulmonary embolism in a 59-year-old man. (a) On a 3.75-mm-thick CT scan, partial volume averaging of vessel and lung creates an artifact that mimics pulmonary embolism within the anterior segment of the left upper lobe pulmonary artery (arrow). Contiguous images demonstrated the true nature of this finding.Download as PowerPointOpen in Image Figure 37. Viewer, Figure 1. (b) CT scan produced with bone window settings clearly depicts the pulmonary artery catheter. Chronic pulmonary embolism in the same patient as in ,Figure 11. adequate enhancement of the pulmonary trunk and its branches. 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). Figure 5a. (a) CT scan shows poor enhancement of the interlobar and middle lobe pulmonary arteries due to flow-related artifact. 05, American Journal of Roentgenology, Vol. Pulmonary embolism (PE) is a relatively common vascular disease with potentially life-threatening complications in the short term. 41, No. (a) Unenhanced CT scan demonstrates subtle regions of hyperattenuation (arrow). Figure 10a. Viewer. Classification of a pulmonary embolism may be based upon: 1. the presence or absence of hemodynamic compromise 2. temporal pattern of occurrence 3. the presence or absence of symptoms 4. the vessel which is occluded Figure 22b. Viewer. 30, No. This partial filling defect surrounded by contrast material produces the polo mint sign (arrow). No timing bolus is necessary unless the patient has a known history of heart disease. 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 7. 5, 1 January 2015 | Polish Journal of Radiology, Vol. Viewer. It is a preferred choice of imaging in the diagnosis of PE due to its minimally invasive nature for the patient, whose only requirement for the scan is an intravenous line. Viewer. Respiratory motion artifact will diminish as higher-order multisection CT, which requires a shorter breath hold, becomes more widely used. However, this increased detector width also decreases sensitivity for detection of pulmonary embolism (,25). Figure 22a. 2, Revista Argentina de Radiología, Vol. (b) CT scan (window width = 552 HU, window level = 276 HU) shows acute pulmonary embolism within the medial segment of the middle lobe artery (arrow) that was missed on the image in a. 3, American Journal of Roentgenology, Vol. 196, No. Adjacent beam-hardening artifacts are also seen.Download as PowerPointOpen in Image 1, 8 August 2017 | Veterinary Radiology & Ultrasound, Vol. Acute pulmonary embolism in a 66-year-old man who presented with chest pain and dyspnea. Such detection can help determine further imaging needs and allow the timely initiation of appropriate therapy. 5, Journal of the Korean Medical Association, Vol. Occult Pulmonary Embolism in Intensive Care Unit Patients Undergoing Chest Computed Tomography Scan: Incidence and Effect on Outcomes, Multi-phase postmortem CT angiography: recognizing technique-related artefacts and pitfalls, Chronic Pulmonary Emboli and Radiologic Mimics on CT Pulmonary Angiography, Primary pulmonary artery myxoma: a rare case, Acute pulmonary embolism in the era of multi-detector CT: a reality in sub-Saharan Africa, Acute and Chronic Pulmonary Embolism: An In-depth Review for Radiologists Through the Use of Frequently Asked Questions, 80-kV Pulmonary CT Angiography With 40 mL of Iodinated Contrast Material in Lean Patients: Comparison of Vascular Enhancement With Iodixanol (320 mg I/mL)and Iomeprol (400 mg I/mL), The role of thoracic imaging in the intensive care unit, Prospectively ECG Gated CT pulmonary angiography versus helical ungated CT pulmonary angiography: Impact on cardiac related motion artifacts and patient radiation dose, Imaging of Congenital and Acquired Disorders of the Pulmonary Artery, Current Role of Imaging in the Diagnosis and Management of Pulmonary Hypertension, Computerassistiertes Diagnoseverfahren für die Mehrschichtcomputertomographie zur Beurteilung der pulmonalarteriellen Strombahn. More distally, the pulmonary arteries were well enhanced. The window width is equal to the mean attenuation of the main pulmonary artery plus two standard deviations, and the window level equals one-half of this value (,29). Figure 28c. Figure 28b. 188, No. Figure 30d. Figure 34a. 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 The apparent pulmonary embolism is ill defined. 10, 10 September 2013 | International Journal of Experimental Pathology, Vol. The radiologist needs to determine the quality of a CT pulmonary angiographic study and whether pulmonary embolism is present. (a) CT scan (window width = 400 HU, window level = 40 HU) demonstrates thrombus within the right interlobar artery (arrow). Figure 40. CT scan reveals that the short axis of the right ventricle (dashed line) is wider than that of the left ventricle (solid line), a situation that was caused by acute pulmonary embolism and created right ventricular strain. 3, Journal of Cardiothoracic and Vascular Anesthesia, Vol. 12, Clinical Pulmonary Medicine, Vol. 6, IEEE Transactions on Biomedical Engineering, Vol. The radiologist needs to determine the quality of a CT pulmonary angiographic study and whether pulmonary embolism is present. 9, No. The apparent pulmonary embolism is ill defined. (a) On a 3.75-mm-thick CT scan, partial volume averaging of vessel and lung creates an artifact that mimics pulmonary embolism within the anterior segment of the left upper lobe pulmonary artery (arrow). The appropriate window width and level settings are important for identifying small emboli, webs, or flaps. Figure 21. Figure 5a. MATERIALS AND METHODS: A multi-detector row spiral CT protocol for the diagnosis of pulmonary embolism was used that consisted of scanning the entire chest with 1-mm collimation within one breath hold. Chronic pulmonary embolism can manifest as complete occlusive disease in vessels that are smaller than adjacent patent vessels. The unenhanced or poorly enhanced blood within the affected vessel may mimic pulmonary embolism. Viewer. Figure 6. Indeterminate CT pulmonary angiogram: Why and does it matter? Pulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated. Figure 25a. (2010) Radiology. (e) More oblique angiogram of the left pulmonary artery also demonstrates no evidence of pulmonary embolism (arrow). Multisection CT venography is simple and accurate, and when combined with lung imaging it allows fast and comprehensive evaluation for thromboembolic disease (,14). 6, 29 June 2015 | Japanese Journal of Radiology, Vol. Note also the medium-sized left pleural effusion and atelectasis. 48, No. (c) CT scan (window width = 700 HU, window level = 100 HU) demonstrates thrombus within the right interlobar artery and the medial segment of the middle lobe artery. In addition, a centrally located, hyperattenuating filling defect is occasionally identified at unenhanced CT, a finding that indicates acute central pulmonary embolism (,,, Fig 10) (, 22). Criteria to be used for Chest CTA or a CT is requested for Pulmonary Emboli which cannot be approved based on Interqual or Milliman criteria. Viewer. Brink et al (,29) suggested a window width equal to the measured mean attenuation of the enhanced main pulmonary artery plus two standard deviations and a window level equal to one-half of this value (,,,,Fig 25). For example, when acquiring images with a 1.25-mm detector width, a set of images with an overlap of 0.625 mm should be retrospectively generated. 196, No. We prefer to scan from bottom to top, because if a patient can't hold his breath, then you will have less breathing artefacts in the lower lobes, where most of the emboli are located. 9, Current Problems in Diagnostic Radiology, Vol. CT NCAP (neck, chest, abdomen and pelvis). Pulmonary artery stump in situ thrombosis in a 69-year-old man who had undergone right pneumonectomy for lung cancer. Figure 19. Figure 24a. 127, No. (c) CT scan (window width = 700 HU, window level = 100 HU) demonstrates thrombus within the right interlobar artery and the medial segment of the middle lobe artery. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to … Flow-related artifact in a 73-year-old woman with chest pain. Image noise in scans of a 39-year-old woman with chest pain. CT scan shows an acute pulmonary embolus that causes a partial filling defect surrounded by contrast material (railway track sign) (arrow). Note the dilated collateral bronchial artery (arrowhead).Download as PowerPointOpen in Image (a) Unenhanced CT scan demonstrates subtle regions of hyperattenuation (arrow). Pulmonary embolism can be difficult to diagnose, especially in people who have underlying heart or lung disease. Although pulmonary angiography has lower mortality and morbidity rates (<1% and 5%, respectively) than anticoagulation therapy (1%–2% and 5%–25%), it has not gained widespread acceptance and is not universally available (,9–,11). 55, No. 30, No. 4, 4 January 2014 | The International Journal of Cardiovascular Imaging, Vol. 50, No. Image noise makes the evaluation of segmental and subsegmental vessels difficult and can cause indeterminate CT pulmonary angiography and misdiagnosis of pulmonary embolism (,Fig 21). Figures 1-3 demonstrate the timing of changes that occur when a new technology replaces an old one; in this case, a downturn in the use of pulmonary angiography and ventilation-perfusion scintigraphy almost exactly coincides with a steep increase in CT pulmonary angiography usage. 6, European Journal of Radiology Open, Vol. 2, American Journal of Roentgenology, 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). 4, Korean Journal of Radiology, Vol. 5, Radiologic Clinics of North America, Vol. 81, No. 58, No. 14, No. Viewer. Images of the iliac, femoral, and popliteal veins are obtained 4 minutes after the onset of enhancement from the initial contrast material injection. For each lung, the main, lobar, segmental, and subsegmental arteries are examined for pulmonary embolism. No embolism was present.Download as PowerPointOpen in Image Localized increase in vascular resistance in a 65-year-old man with dyspnea. The low-attenuation abnormality due to partial volume averaging of vessel and lung can simulate pulmonary embolism (,,,Fig 20b). 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. Ju Hee Yeo, Lifeng Zhou, Remy Lim. (c) CT scan (window width = 700 HU, window level = 100 HU) demonstrates thrombus within the right interlobar artery and the medial segment of the middle lobe artery. 16, No. (,Fig 1 modified and Figs 1-3 reprinted, with permission, from reference ,12. 4, The Journal of Thoracic and Cardiovascular Surgery, Vol. 12, No. With a 1.25-mm detector width, normal or enlarged lymphatic tissue can be more easily distinguished from acute or chronic pulmonary embolism because lymphatic tissue is extramural and the normal smooth contour of the contrast material–filled vessel is preserved (,,,,,Fig 30). 6, 28 June 2017 | Respirology Case Reports, Vol. 202, No. 50, No. Figure 25c. Figure 34a. The apparent pulmonary embolism is ill defined. 5, No. Further imaging may be necessary, consisting of either repeat CT pulmonary angiography with an increased delay or pulmonary angiography. Viewer. Graph illustrates that the number of pulmonary angiographic studies performed per inpatient with suspected thromboembolic disease decreased significantly between 1992 and 2001 (P = .02). Hilar lymph nodes in the lungs can be conveniently divided into upper lobe, interlobe, middle lobe (lingular), and lower lobe groups (,31,,32). This artifact can be recognized by its nonanatomic nature and is easily distinguished from pulmonary embolism. Note also the fluid-filled, dilated esophagus. Figure 38. Factors that cause misdiagnosis of pulmonary embolism may be patient related, technical, anatomic, or pathologic. (b, c) CT scans obtained immediately superior (b) and inferior (c) to a demonstrate an apparent ill-defined filling defect (arrow) that is too high in attenuation to represent pulmonary embolism. Acute pulmonary embolism in a 66-year-old man who presented with chest pain and dyspnea. CT scan shows a large tumor embolus within the right lower lobe pulmonary artery (arrow).Download as PowerPointOpen in Image 1, 28 July 2016 | Journal of Medical Imaging and Radiation Oncology, Vol. Note also the medium-sized left pleural effusion and atelectasis. Figure 38. Figure 15. Viewer. The posterobasal segment of the right lower lobe bronchus is dilated as well as mucus filled. CT scan reveals a small, recanalized pulmonary artery with contrast material in the central lumen (arrow). For patients with contraindications to conventional catheter pulmonary angiography. 44, No. Note also the medium-sized left pleural effusion and atelectasis. 80, 1 October 2015 | Radiologia Brasileira, Vol. 3. 3, Journal of Thoracic Imaging, Vol. (a) CT scan shows a flow artifact caused by a localized increase in vascular resistance (arrow), a finding that can mimic acute pulmonary embolism. (Fig 1 modified and Figs 1-3 reprinted, with permission, from reference ,12. 3, 14 February 2017 | Internal and Emergency Medicine, Vol. CT scan shows a flap (arrow) within a small right interlobar pulmonary artery. Figure 27a. The computed tomography pulmonary angiogram (CTPA/CTPE) is a commonly performed diagnostic examination to exclude pulmonary emboli. Beam-hardening artifact in a 63-year-old man with respiratory failure. (e) More oblique angiogram of the left pulmonary artery also demonstrates no evidence of pulmonary embolism (arrow).Download as PowerPointOpen in Image Motion artifact renders the diagnosis of pulmonary embolism at this anatomic level indeterminate. Unlike true emboli, however, these apparent abnormalities are not well-defined filling defects. (a) Unenhanced CT scan demonstrates subtle regions of hyperattenuation (arrow). (a) CT scan (window width = 400 HU, window level = 40 HU) demonstrates thrombus within the right interlobar artery (arrow). 62, 7 August 2018 | Current Radiology Reports, Vol. Small pulmonary emboli are noted in the left pulmonary artery. Viewer. Small pulmonary emboli are noted in the left pulmonary artery. Edema caused by raised left atrial pressure can produce peribronchovascular interstitial thickening, which mimics chronic pulmonary embolism at CT pulmonary angiography. Figure 27b. Multiplanar reformatted images through the longitudinal axis of a vessel are sometimes used to overcome various difficulties encountered with axial sections of obliquely or axially oriented arteries (,13). (b) CT scan (window width = 552 HU, window level = 276 HU) shows acute pulmonary embolism within the medial segment of the middle lobe artery (arrow) that was missed on the image in a. 5, No. However, these modified window settings can also increase the conspicuity of artifacts caused by image noise and flow. However, some morphologic abnormalities that suggest right ventricular failure can be quantified with CT pulmonary angiography. 5, 1 January 2009 | RadioGraphics, Vol. Viewer. Viewer. The window width is equal to the mean attenuation of the main pulmonary artery plus two standard deviations, and the window level equals one-half of this value (,29). Figure 39. Acute pulmonary embolism in a 58-year-old woman who presented with chest pain and dyspnea. Left-sided heart failure in a 56-year-old woman with dyspnea. Viewer. (a) CT scan shows a flow artifact caused by a localized increase in vascular resistance (arrow), a finding that can mimic acute pulmonary embolism. Pulmonary CT angiography (CTA) is the imaging modality of choice in suspected acute pulmonary embolism (PE). Identification of the catheter with bone window settings (,,,Fig 22) or on contiguous images or the scout image will demonstrate the true nature of this pitfall. Virchow (,36) postulated that thrombus formation is caused by vessel injury, disturbance of blood flow, and hypercoagulability. Supine Contrast IV: Up to 100 ml Omni 350. Figure 14. 29, No. Computed Tomography (CT) is the mainstay of diagnostic imaging evaluation of thoracic disorders. Figure 9. (b) CT scan produced with bone window settings clearly depicts the pulmonary artery catheter. Intravenous Contrast Medium Administration and Scan Timing at CT: Considerations and Approaches1. CONCLUSION: A simple empiric timing protocol for CTPA has robust performance compared to a timing bolus protocol. (b) Contiguous CT scan obtained inferior to a demonstrates normal lung adjacent to the left upper lobe pulmonary artery. A focal increase in vascular resistance can result from lung consolidation or atelectasis, is a cause of indeterminate CT pulmonary angiography, and can cause misdiagnosis of pulmonary embolism (,,,,,,Fig 35) (,35). Figure 28b. Figure 25 illustrates the effect of different window settings on detection of pulmonary embolism.Download as PowerPointOpen in Image 85, No. Large tumor emboli, a rare cause of intravascular filling defects, result from direct invasion of the inferior vena cava or its major branches by hepatoma, renal cell carcinoma, or choriocarcinoma (,42). Parenchymal density changes in acute pulmonary embolism: Can quantitative CT be a diagnostic tool? (b) Contiguous CT scan obtained inferior to a demonstrates normal lung adjacent to the left upper lobe pulmonary artery. 5, Journal of Thoracic Imaging, Vol. The window width is equal to the mean attenuation of the main pulmonary artery plus two standard deviations, and the window level equals one-half of this value (,29). 4, Seminars in Roentgenology, Vol. Figure 35d. 21, No. 45, No. Accompanying CT findings in heart failure include diffuse ground-glass attenuation, interlobular septal thickening and diffuse peribronchovascular interstitial thickening, and bilateral pleural effusions (,,,Fig 34). (b, c) CT scans obtained immediately superior (b) and inferior (c) to a demonstrate an apparent ill-defined filling defect (arrow) that is too high in attenuation to represent pulmonary embolism. Localized increase in vascular resistance in a 65-year-old man with dyspnea. Pulmonary arterial hypertension secondary to chronic pulmonary embolism in the same patient as in ,Figure 12. CTPA is currently regarded as the reference standard for confirming the diagnosis of pulmonary embolism. (a) CT scan shows peribronchovascular interstitial thickening caused by perivascular edema (arrow), a finding that can mimic chronic pulmonary embolism. 1, Journal of the Korean Society of Radiology, Vol. Figure 27a. CT scan shows low-attenuation lines that traverse a vessel on coronal reformatted images (arrows). Is greater than 78 HU (,28 ) shows unenhanced pulmonary veins ( arrows,... Contraindications to conventional catheter pulmonary angiography in oncology-population differ from that in non-oncology?... Left pleural effusion and atelectasis of blood flow, and results in many deaths each year compared adjacent... And whether pulmonary embolism Current Radiology Reports, Vol Download as PowerPointOpen in Image Viewer chest of! 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Egyptian Journal of Radiology, Vol flap ( arrow ) help determine further Imaging may be normal or poor..., or indeterminate normal-appearing contrast material–filled accompanying pulmonary arteries are examined for pulmonary embolism in left. Enhancement may obscure thrombus determine the quality of a CT pulmonary angiography in of! Often not sharp, 13 April 2012 | Der Radiologe, Vol ill-defined margins and demonstrating... Large amount of Image noise.Download as PowerPointOpen in Image Viewer the result axial. Posterobasal segment of the left pulmonary artery protocol for 16-Section CT of pulmonary embolism.Download as PowerPointOpen in Viewer! And Jonas Widell et al the signs and symptoms are inconsistent, the Egyptian Journal the. | Expert review of Cardiovascular therapy, Vol November 2007 | Radiology, ct pulmonary embolism protocol acute emboli affect! Lung ( arrowheads ) that are smaller than adjacent patent vessels these Radiologic features not! 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