Source: Annual Congress 2010 - State of the art imaging
Disease area: Pulmonary vascular diseases, Respiratory infections

Abstract

Background: The diagnosis of peripheral pulmonary embolism remains a challenge, particularly when emboli appear to be present in small peripheral vessels only.
Method: Retrospective analysis of 64-slice CTPA images acquired between January 2009 and December 2009. Those reported positive for pulmonary embolism by a radiologist were subsequently reviewed by a SHO, a respiratory consultant and a different radiologist. The exact location of clot within the pulmonary arteries and the presence of associated pleural and parenchymal change distal to clot was recorded.
Results: 439 sequential CTPAs were analysed (214 male and 225 female – mean age 66). 81 scans were reported as showing pulmonary embolism (18.5%). 51 male and 30 female. 16.7% of PEs were in the main pulmonary trunks, 49.3% were in the lobar branches and 34% were in the segmental and subsegmental arteries. 63% of PEs were bilateral, 27.2% were unilateral on the right side and 9.8% were unilateral left side. Parenchymal and pleural changes were seen in 38% of positive CTPAs. Of the scans showing clot in the main pulmonary trunks, 13.7% had pleural or intrapulmonary change. This figure rose to 40% when the clot was seen in the lobar pulmonary arteries and 52% when clot was confined to segmental or subsegmental arteries.
Conclusion: Possibly reflecting the lack of bronchial circulation distally, this study suggests that emboli in peripheral segmental and subsegmental arteries are more likely to be associated with pleural and parenchymal change. The absence of such changes might alert clinicians to the possibility that small peripheral filling defects in segmental and subsegmental pulmonary arteries are artefactual.

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Citations should be made in the following way:
K. Johnston, A. Warley, K. Johnson (United Kingdom). Can pleural and lung parenchymal changes assist in the diagnosis of pulmonary embolism on multi-slice CTPA?. Eur Respir J 2010; 36: Suppl. 54, 5282

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