Pulmonary arteries: imaging of pulmonary embolism and beyond

Leitman, Ellen M.; McDermott, Shaunagh

doi:10.21037/cdt.2018.08.05

Cited by 21 publications

(19 citation statements)

References 110 publications

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“…The CTPA is the first preferred imaging method for the diagnosis of PE and is found in almost every emergency department (26). The CTPA can rapidly show both vascular structures and additional pathologies.…”

Section: Discussionmentioning

confidence: 99%

Validity of the Ratio of Pulmonary Artery Diameter to Aortic Diameter in the Diagnosis of Pulmonary Embolism in the Emergency Department

2022

ircmj

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Background: Pulmonary thromboembolism can be easily diagnosed with computed tomography (CT) and pulmonary angiography (CTPA). However, diagnosis is difficult since a contrast agent cannot be used. Several criteria are recommended for the diagnosis of pulmonary embolism (PE) with non-enhanced CT. Objectives: The aim of this study is to investigate the value of the increase in the pulmonary artery diameter (PA-D) and the ratio of the pulmonary artery diameter / ascending aorta diameter (Ao-D) ratio (PA-D/Ao-D) in the diagnosis of PE in the emergency department (ED). Methods: The CTPA of patients diagnosed with PE (n=88) and a control group (n=89) were examined retrospectively. The main PA (MPA), right MPA (RMPA), left MPA (LMPA), and Ao-D were measured. The ratio of PA-D and Ao-D was calculated. Results: Mean age of participants of this study was 67.85±17.03 (Min:18, Max:98) in the PE group and 67.31±20.17 (Min:20, Max:91) in the control group (P=0.272). The PE diagnosis of RMPA, right segmental PA, and right subsegmental PA were found to be more than the left side. Moreover, the mean D-Dimer levels were found to be higher in the PE group (7.31±3.528 mcg/L), compared to the control group (1.52±1.042 mcg/L) (P=0.000). In the PE group, the mean Ao-D (35.14±4.55 mm) was larger, compared to the control group (34.97±5.28 mm); however, it was not statistically significant (P=0,828). In the PE group, the average MPA diameter (MPA-D) (30.45±4.77 mm) was larger than that of the control group (28.35±3.81 mm) and statistically significant (P=0,001). In addition, in the PE group, the average MPA-D/Ao-D ratio (0.87±0.15) was higher in comparison to the control group (0.82±0.13) (P=0,016). Conclusion: The increase in PA-D and PA-D/Ao-D ratio can be used in the diagnosis of PE when contrast agent cannot be given on CT or when thrombus cannot be seen on CT for the diagnosis of PE in the ED.

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Section: Discussionmentioning

confidence: 99%

Validity of the Ratio of Pulmonary Artery Diameter to Aortic Diameter in the Diagnosis of Pulmonary Embolism in the Emergency Department

2022

ircmj

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“…As the PI evolves, it reduces in size from the periphery ("melting sign") and becomes more nodular in appearance. [29] Acute PE may also lead to RV dysfunction, with characteristic CTA signs including increased ventricular cavity diameter, flattening or leftward deviation of the interventricular septum and reflux of contrast medium into the inferior vena cava and hepatic veins. [30] As a result of increased A c c e p t e d m a n u s c r i p t right atrial pressure, the superior vena cava and azygos vein may also appear dilated (if >20.9mm and >10.4mm in diameter, respectively)(Figure 5).…”

Section: Acute Pulmonary Embolism Findings In Computed Tomography Angiographymentioning

confidence: 99%

Pulmonary embolism and computed tomography angiography: Characteristic findings and technical advices

Muscogiuri¹,

Girolamo²,

Dedominicis³

et al. 2021

Imaging

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Pulmonary embolism (PE) is a condition due to blood clots obstructing pulmonary arteries, often related to deep venous thrombosis (DVT). PE can be responsible for acute and even life-threatening clinical situations and it may also lead to chronic sequelae such as chronic thromboembolic pulmonary hypertension (CTEPH). Signs and symptoms associated to PE may overlap those of many other diseases (e.g. chest pain, dyspnea, etc.), therefore an accurate clinical evaluation is mandatory before referring the patient to the most appropriate imaging technique. Pulmonary angiography (PA) has been traditionally considered the gold standard regarding the diagnosis of PE and it is also useful regarding the treatment of said condition. However, PA is an invasive technique, implying all the known risks concerning endovascular procedures. Nowadays, computed tomography angiography (CTA) is considered the imaging technique of choice regarding the diagnosis of PE. This technique is readily-available in most centers and it is able to provide high resolution images, although it implies the administration of ionizing radiations and iodinated contrast medium. Conventional CTA has further been improved with the use of ECG-gated protocols, aimed to reduce motion artifacts due to heartbeat and to evaluate other causes of sudden onset chest pain. Moreover, another interesting technique is dual energy computed tomography (DECT), which allows to elaborate iodine maps, allowing to detect areas of hypoperfusion due to the presence of emboli in pulmonary arteries. This review is aimed to describe the main findings related to PE with an emphasis on CTA, also discussing technical aspects concerning image acquisition protocol.

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“…The blood gas analysis revealed refractory hypoxemia without carbon dioxide retention and normal lactic acid levels. Regarding imaging examinations [20], pulmonary CT is more sensitive than conventional chest X-ray for PAVM detection and can be used to identify almost all PAVMs. Thus, pulmonary CT examinations are the preferred diagnostic imaging method.…”

Section: Diagnosismentioning

confidence: 99%

“…CTA can stereoscopically display 3D images of the PAVM to show highdensity intrapulmonary nodular or mass shadows. Simultaneous enhancement of the lesions on adjacent large vessels is possible and is characterized by a "vascular pedicle" sign or "aneurysm" sign and premature imaging of the left atrium [20]. Moreover, echocardiography is highly necessary since congenital pulmonary vascular malformations are often accompanied by cardiac anomalies.…”

Section: Diagnosismentioning

confidence: 99%

A boy with refractory cyanosis: pediatric pulmonary arteriovenous malformation case report and literature review

Sheng¹,

Yang²,

Yu³

et al. 2020

Preprint

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Background: Pulmonary arteriovenous malformation is rare and is defined as the presence of an abnormal connection between the pulmonary artery and vein. Pulmonary arteriovenous malformation can manifest with no obvious clinical symptoms and is only found incidentally on pulmonary imaging examinations. The clinical signs vary according to the shunt flow in proportion to the malformation area. In severe cases, symptoms such as exertional dyspnea, cyanosis, hemoptysis or even sudden death can occur. Untreated pulmonary arteriovenous malformation may result in cardiac failure or rupture of the aneurysmal fistula.Case presentation: We report the case of a 1-year-old boy who presented with refractory cyanosis and a transcutaneous oxygen saturation level of 70-76%.Pulmonary arteriovenous malformation was detected on computed tomography angiogram. We chose surgical resection of the diseased lung as the treatment. The boy had a good prognosis and was followed up for 3 months without recurrence. The analysis of this case and a review of the literature improved our understanding of pulmonary arteriovenous malformation.Conclusion: Pulmonary arteriovenous malformation should be considered when unexplained conditions such as hypoxia and hemoptysis are encountered or when pulmonary arteriovenous malformation-like mass changes are visible on chest imaging. The early identification of the problem, diagnosis, treatment and follow-up are helpful for reducing trauma and for improving the long-term outcome of children with pulmonary arteriovenous malformation.

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Pulmonary arteries: imaging of pulmonary embolism and beyond

Cited by 21 publications

References 110 publications

Validity of the Ratio of Pulmonary Artery Diameter to Aortic Diameter in the Diagnosis of Pulmonary Embolism in the Emergency Department

Validity of the Ratio of Pulmonary Artery Diameter to Aortic Diameter in the Diagnosis of Pulmonary Embolism in the Emergency Department

Pulmonary embolism and computed tomography angiography: Characteristic findings and technical advices

A boy with refractory cyanosis: pediatric pulmonary arteriovenous malformation case report and literature review

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