Thrombotic and Nonthrombotic Pulmonary Arterial Embolism: Spectrum of Imaging Findings

Han, Daehee; Lee, Kyung Soo; Franquet, Tomás; Müller, Néstor L.; Kim, Tae Sung; Kim, Hojoong; Kwon, O Jung; Byun, Hong Sik

doi:10.1148/rg.1103035043

Cited by 203 publications

(104 citation statements)

References 84 publications

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“…In fact, liver abscesses have been reported to be one of the major causes of septic pulmonary emboli (14). Although thoracic empyema is a complication often seen in patients with septic pulmonary emboli (15), this complication was not observed in our cases.…”

Section: Discussionmentioning

confidence: 49%

Emphysematous Liver Abscesses Complicated by Septic Pulmonary Emboli in Patients with Diabetes: Two Cases

et al. 2013

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An emphysematous liver abscess is a fatal condition that often occurs in patients with uncontrolled diabetes mellitus. I herein describe two cases of Klebsiella pneumoniae-induced emphysematous liver abscesses complicated by septic pulmonary emboli in patients with poorly controlled diabetes mellitus. Both patients showed hemoglobin A1c levels of more than 10% and did not present with any abdominal symptoms on admission. However, they were diagnosed and successfully treated with percutaneous transhepatic abscess drainage and antibiotics. This fatal disease should be taken into consideration in patients with uncontrolled diabetes mellitus who suffer from prolonged fevers and uncharacteristic general malaise.

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Section: Discussionmentioning

confidence: 49%

Emphysematous Liver Abscesses Complicated by Septic Pulmonary Emboli in Patients with Diabetes: Two Cases

et al. 2013

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“…Other signs include a partial filling defect surrounded by contrast material, the ''polo mint'' sign on images acquired perpendicular to the long axis of a vessel, the ''railway track'' sign on longitudinal images of the vessel, and a peripheral intraluminal filling defect that forms acute angles with the arterial wall [5,6]. All these …”

Section: Pulmonary Arterial Signsmentioning

confidence: 99%

Magnetic resonance imaging findings in acute pulmonary embolism

Hochhegger¹,

Ley‐Zaporozhan²,

Marchiori³

et al. 2011

BJR

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ABSTRACT. Pulmonary embolism (PE) is the third most common acute cardiovascular disease after myocardial infarction and stroke, and results in thousands of deaths each year. Improvements in MRI accuracy are ongoing with the use of parallel imaging for angiography techniques and pulmonary perfusion. This, associated with other potential advantages of MRI (e.g. a radiation free method and better safety profile of MR contrast media), reinforces its use. The aim of this paper is to perform a pictorial review of the principal findings of MRI in acute PE. Acute PE can manifest itself as complete arterial occlusion and the affected artery may be enlarged. We report the main vascular and parenchymal signs, and an overview of current literature regarding accuracy, limitations and technical aspects is provided. Diagnostic strategies for pulmonary embolism (PE) have evolved over the last few decades with the development of new diagnostic methods. Initially, the time required for an MR examination and the lack of MR-compatible monitoring devices hindered the broad clinical acceptance of this method. Recently, significant technical developments in pulmonary MR angiography have occurred. Improvements include the use of parallel imaging, view-sharing, time-resolved echo-shared angiography [1, 2] and pulmonary perfusion. These techniques have shortened the acquisition time of MR angiography, improved spatial resolution and made it less susceptible to motion artefacts. In addition to classical MR angiography, other sequence types have been developed for more rapid acquisition of images and additional functional information.The increased use of multidetector CT (MDCT) scanning has raised concerns about overall radiation exposure to the population, and has emphasised the need in the radiology community for optimised scanning protocols [3]. MRI does not require ionising radiation, or iodated contrast media, and is associated with less renal impairment than MDCT. Thus, MRI appears to be the ideal imaging modality for use in ruling out PE.The aim of this paper is to provide a pictorial review of MRI in PE diagnosis, and assess its accuracy through a review of the literature. MRI techniqueThe proposed MRI protocol for PE diagnosis consists of real-time MR, MR perfusion imaging and MR angiography [3]. This basic evaluation protocol can be easily extended to match individual demands like the assessment of right and/or left ventricular function or the visualisation of the abdominal/pelvic and lower limb veins. The examination protocol first addresses fast overview sequences that ensure short examination times for use with patients in critical condition. Subsequently, the protocol presents a more comprehensive evaluation of the pulmonary arteries, for use with patients with less serious conditions ( Table 1). The total time of acquisition is therefore dependent on the depth of the evaluation and lasts anywhere between 3 and 20 min. The achieved diagnostic accuracy is, at each step, balanced against the patient's condition (30-50 s for tra...

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“…Generally in complete thromboembolic occlusion the affected parenchyma perfusion is performed by bronchial collateral circulation and thus secondary ventilation and perfusion disturbances do not occur. Mosaic perfusion appearance of the parenchyma is more evident later, in the CTA acquisition and not during the early arterial phase (10).…”

Section: Acute Pementioning

confidence: 90%

Focus on pulmonary embolism imaging: where are we?

Dumitrescu¹,

Capsa²,

Lupescu³

2014

JTMR

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Purpose: This paper aims to realize an analysis of available radio-imaging methods for outlining various forms of pulmonary embolism (acute or chronic) with highlights on the semiology and adequate medical indications. Methods: There are several types of radiological examinations used in the evaluation of pulmonary embolism such as perfusion scintigraphy V/Q, digital subtraction angiography, computer tomography angiography, magnetic resonance angiography and cardio-pulmonary radiography. Results: Based on existing studies to date and the informations accumulated in our Department of Radiology and Medical Imaging, we have outlined an imaging pathway in pulmonary embolism assessment. Conclusions: Computer tomography angiography is actually considered the gold standard of diagnosis in suspected acute pulmonary embolism. Digital substraction angiography plays a primary adjuvant therapeutic role or a diagnostic role in case of inconclusive computer tomography angiography examinations. In case of chronic thrombembolic pulmonary hypertension, computer tomography angiography serves as a confirmation tool for the thromboembolic etiology and in conjunction with digital subtraction angiography is mapping the emboli vital for curative thrombendarterectomy. Computer tomography angiography proves its role in the diagnosis of unsuspected pulmonary embolism in oncological patients, discovery that has a negative impact on patient prognosis. In cases where computer tomography angiography refute the diagnosis of pulmonary, the examination may reveal other causes that may explain the patient's symptoms with medical impact. Digital subtraction angiography maintains especially a therapeutic role. Magnetic resonance angiography starts to become of interest in the evaluation and follow-up of subacute or chronic pulmonary embolism. Chest X-ray has not changed over time its place in pulmonary embolism assessment and continues to be of secondary importance.Key words: pulmonary embolism (PE), computer tomography angiography (CTA), angiography with digital substraction, magnetic resonance angiography (MRA), cardio-pulmonary radiography (chest X-ray) INTRODUCTION INTRODUCTIONPulmonary embolism (PE) is considered to be the third cause of death after myocardial infarction and cerebral vascular accident. Risk of death in acute massive PE is approximately 15% and is considered to be lethal in up to 5% of

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Thrombotic and Nonthrombotic Pulmonary Arterial Embolism: Spectrum of Imaging Findings

Cited by 203 publications

References 84 publications

Emphysematous Liver Abscesses Complicated by Septic Pulmonary Emboli in Patients with Diabetes: Two Cases

Emphysematous Liver Abscesses Complicated by Septic Pulmonary Emboli in Patients with Diabetes: Two Cases

Magnetic resonance imaging findings in acute pulmonary embolism

Focus on pulmonary embolism imaging: where are we?

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