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Helical CT Diagnosis of PTE. Bill Lee. Pulmonary Thromboembolism: Spectrum of Findings on CT Creaves S, et. al. American Journal of Roentgenology 1995;165:1359-1363. PTE. Filling defect in pulm. art. post-contrast Widenening, blunting, abrupt termination of arteries

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Pulmonary Thromboembolism: Spectrum of Findings on CTCreaves S, et. al.American Journal of Roentgenology1995;165:1359-1363


PTE

  • Filling defect in pulm. art. post-contrast

  • Widenening, blunting, abrupt termination of arteries

  • Lung parenchyma distal to thrombus may be oligemic (decrease in vessel number or caliber +/- decrease in pulm. attenuation)

  • Thrombosis of multiple small pulm aa. – patchy decrease in attenuation (“mosaic oligemia”)


PTE

  • Pulmonary infarcts – triangular to polyhedral focal region of increased parenchymal attenuation distal to thrombus

  • “Vascular sign” – thickened or thrombosed vessel leading to apex of infarct

  • Pleural effusion – often hemorrhagic, likely secondary to pulm. necrosis


“Mosaic oligemia”

Pulmonary Infarct


Vascular sign (w/PTE) and infarct

PTE and pleural fluid


PTE

  • False + and false – from insufficient pulmonary artery contrast enhancement

  • False + from confusing adjacent lymph nodes with art. thrombi


“Pseudothrombus” = right hilar lymphadenopathy (arrowhead),

PTE in left descending pulmonary art. (arrow)


Pseudothrombus
“Pseudothrombus” (arrowhead),

  • Streamlining

0 Sec Post

30 Sec Post


Ncsu cases
NCSU Cases (arrowhead),

  • 10y, MC Silky Terrier

  • Hepatocarcinoma

  • Met Check

  • Normal thorax

  • link


Ncsu cases1
NCSU Cases (arrowhead),

  • Adjust window and level

    • Lung parenchyma (W≈1500, L≈-500)

    • PTE (W≈500, L≈0)

  • Review transverse, sagittal and dorsal plane images

  • Review different post-contrast times

    • Often good pulm. art. opacification at ≈ 1 min.

  • 1mm images best for small lesions


Ncsu cases2
NCSU Cases (arrowhead),

  • 8 Y, MC, Border Collie

  • Increased resp. rate

  • Exercise intolerance

  • Hypoxemia

  • Transverse , 75 sec post


Ncsu cases3
NCSU Cases (arrowhead),

  • 10 y, MC Beagle

  • Suspect glucagonoma

  • Previous heartworm dz possible

  • Dorsal


Ncsu cases4
NCSU Cases (arrowhead),

  • 8y, FS, Golden Retriever

  • Adrenal mass

  • Hyperadrenocorticism

  • Dorsal


CT Angiography for Diagnosis of Pulmonary Embolism: State of the ArtSchoepf U, et. al.Radiology, 2004;230:329-337


  • Surpassed scintigraphy as first-line imaging test for PTE the Art

  • Many advantages of CT over other imaging

    • med. and parenchymal struct. can be evaluated

    • thrombus can be directly visualized

    • interobserver agreement for CT better than scint.

    • more cost-effective than algorithms that do not include CT


  • Historical limitation of this modality - detection of small peripheral emboli (single–detector row CT)

  • Multislice helical CT= increased speed, decreased motion artifact (entire thorax in single breath hold), increased spatial resolution, isotropic voxels & 3D reformatting

  • = improved detection of small peripheral emboli






? associated infarct


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