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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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slide2
Pulmonary Thromboembolism: Spectrum of Findings on CTCreaves S, et. al.American Journal of Roentgenology1995;165:1359-1363
slide3
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”)
slide4
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
slide6

“Mosaic oligemia”

Pulmonary Infarct

slide8
PTE
  • False + and false – from insufficient pulmonary artery contrast enhancement
  • False + from confusing adjacent lymph nodes with art. thrombi
slide9

“Pseudothrombus” = right hilar lymphadenopathy (arrowhead),

PTE in left descending pulmonary art. (arrow)

pseudothrombus
“Pseudothrombus”
  • Streamlining

0 Sec Post

30 Sec Post

ncsu cases
NCSU Cases
  • 10y, MC Silky Terrier
  • Hepatocarcinoma
  • Met Check
  • Normal thorax
  • link
ncsu cases1
NCSU Cases
  • 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
  • 8 Y, MC, Border Collie
  • Increased resp. rate
  • Exercise intolerance
  • Hypoxemia
  • Transverse , 75 sec post
ncsu cases3
NCSU Cases
  • 10 y, MC Beagle
  • Suspect glucagonoma
  • Previous heartworm dz possible
  • Dorsal
ncsu cases4
NCSU Cases
  • 8y, FS, Golden Retriever
  • Adrenal mass
  • Hyperadrenocorticism
  • Dorsal
slide16
CT Angiography for Diagnosis of Pulmonary Embolism: State of the ArtSchoepf U, et. al.Radiology, 2004;230:329-337
slide17

Surpassed scintigraphy as first-line imaging test for PTE

  • 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
slide18

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
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