Pulmonary Thromboembolism Revisited: The Radiologist's View

• Autor(a) principal: Preto,Ana Sofia
• Data de Publicação: 2010
• Outros Autores: Rocha,Diogo Monteiro, Campos,José Traila, Carneiro,Alexandre Lima, Gonçalves,José Fonseca
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0871-34132010000300004
• topic: pulmonary thromboembolism; diagnosis; prognosis

The authors have the following objectives: to review the mechanism and causes of Acute and Chronic Pulmonary Thromboembolism, to review clinical guidelines on when to ask for imagiological exams, to present the key imaging findings of this entity on 64-MDCT, to describe potential complications and identify possible pitfalls. MDCT angiography of the pulmonary arteries is very frequently performed to rule out Pulmonary Embolism at the emergency scene. If not recognized and treated it has an overall mortality of 30%. Sometimes, asymptomatic emboli organize, turning into a chronic picture. When there is pulmonary hypertension associated it results in cor pulmonale. After revision of some illustrative cases of Pulmonary Thromboembolism (PTE) from our institution, the authors realize that the classical conventional radiology signs are “hard to see”. The diagnostic criteria for acute PTE always include the presence of a filling defect on an arterial branch of pulmonary vasculature on MDCT. There are some variants presented on this essay. Chronic PTE may include signs of complete occlusion of a vessel that is smaller than adjacent patent vessels and a peripheral, crescent-shaped intraluminal defect that forms obtuse angles with the vessel wall, and contrast material flowing through thickened and often smaller arteries due to recanalization. The conclusions drawn from this paper might be summarized like this: MDCT is determinant for the diagnosis of this entity with its direct and indirect signs; differential diagnosis must be considered, as their treatment and prognosis might be very different; imagiological artifacts are among the worst pitfalls for the radiologist.