Abstract

Acute Pulmonary Embolism

posted by Thorsten R. C. Johnson, M.D. | Mar 5, 2008

Case History

67-year old with severe dyspnea and positive D-dimer test is referred for CT angiography to confirm or to rule out pulmonary embolism.

Question

The primary clinical concern is pulmonary embolism, and other questions include infarction or right heart dilatation.

Diagnosis / Differential diagnosis

Apart from acute pulmonary embolism, differential diagnoses include right heart failure, pulmonary hypertension, congestive heart failure, coronary artery disease, pneumonia and pneumothorax.

Findings

Thrombus clots are visualized in the right upper and the right lower lobar pulmonary arteries. Only the clot formation in the right upper lobe leads to lung infarction, whereas the clots in the lower lobe arteries do not.

Comments

Spiral dual energy CT of the lung can display the perfusion defect or the infracted territory of the lung independent of the direct visualization of thrombi in the pulmonary arteries. This provides a new functional aspect which makes a more comprehensive assessment possible, including the clinical more relevant effect of pulmonary emboli on peripheral perfusion.

[1] Coronal view with presentation of wedge shaped infracted lung area in the right upper lobe.	[2] Axial view demonstrated perfusion deficits in the left and right upper lung due to infarction.
[3] Completely occluding clot in the right upper lobe and partially occluding clot in the right lower lobe, the latter without corresponding perfusion defect.	[4] Normal lung perfusion in the axial view for reference.
[5] Normal lung perfusion displayed in coronal view.