Non-traumatic thoracic emergencies: CT diagnosis of acute pulmonary embolism: the first 10 years

Abstract

Over the past 10 years, spiral CT angiography of the pulmonary arteries has reached a high accuracy in the evaluation of pulmonary embolism. Major advantages of CT compared with ventilation/perfusion lung scintigraphy and pulmonary angiography is direct visualization of clots in the pulmonary arteries, and to provide alternative findings or diagnosis. The recent introduction of multislice CT has improved the evaluation of peripheral pulmonary arteries, enabling high-resolution CT examinations over the entire thorax in a short breathhold. The examination techniques, imaging findings, pitfalls, and results of CT in the diagnosis of pulmonary embolism are reviewed in comparison with other diagnostic tests.

Occurrence of Cardiovascular Events After the 2011 Great East Japan Earthquake and Tsunami Disaster

“…The diagnosis of CHF was made using the generally accepted Framingham criteria 17) and other relevant information, including a history of dyspnea and symptomatic exercise intolerance with signs of pulmonary congestion or peripheral edema, the presence of moist rales on auscultation, or documentation of left ventricular enlargement or dysfunction by chest X-ray or echocardiography. The diagnosis of pulmonary thromboembolism was based on the criteria recommended by Ghaye, et al 18) OHCA was defined as cessation of cardiac mechanical activity that occurs outside of the hospital setting and was confirmed by the absence of signs of circulation. 19,20) The arrest was presumed to be of cardiac etiology unless it was caused by trauma, drowning, drug overdose, asphyxia, exsanguinations, or any other noncardiac cause.…”

Age-Dependent D-dimer Cut-off to Avoid Unnecessary CT-Exams for Ruling-out Pulmonary Embolism

“…Standardized assessment of the reconstructed series was performed in the lung window (window width 1200 HU, center -600 HU), soft tissue window (window width 400 HU, center 40 HU) and in a CTPA-specific window (window width 700 HU, center 250 HU) on at least two planes. Only the direct indication of a PE was assessed as a certain criterion for the presence of a pulmonary embolus, i. e. a complete filling defect in the pulmonary arterial tree, a central defect highlighted by contrast agent, or an eccentric defect, surrounded by contrast agent at an acute angle to the vascular wall [20].…”

Role of Computed Tomography and Magnetic Resonance Imaging for Deep Venous Thrombosis and Pulmonary Embolism

“…2,3 The sensitivity and specificity of CTPA for diagnosis of acute PE have been reported to range from 53% to 100% and 67% to 100%, respectively, varying on the basis of patient selection, extent of thrombus, area of the vasculature imaged, interpretation criteria, and experience of the reader. 1 Moreover, technological advances over the last 10 years have improved spatial resolution (thinner collimation), abbreviated image acquisition time, and enabled multislice imaging.…”

“…At the opening of the third millennium, in many institutions, helical (spiral) CT pulmonary angiography (CTPA) has become the initial imaging study of choice for evaluating patients with suspected PE, supplanting ventilation/perfusion (V/Q) scintigraphy by reducing indeterminate examinations. [1][2][3][4] CT venography (CTV) of the pelvic and lower extremity veins after CTPA of the pulmonary arteries has been advocated by some as an adjunct to helical CT for detection of concurrent deep venous thrombosis (DVT) using a single imaging technique for detection of venous thromboembolic disease.…”