Figure 22b. 5, No. 38, No. If the quality of the study is poor, the radiologist should identify which pulmonary arteries are rendered indeterminate and whether additional imaging is necessary. 9, The Journal of Emergency Medicine, Vol. Figure 37. On occasion, intravascular thrombosis is identified in a pulmonary artery stump. 2, 22 September 2015 | Journal of Magnetic Resonance Imaging, Vol. Beam-hardening artifact in a 63-year-old man with respiratory failure. Indeterminate CT pulmonary angiogram: Why and does it matter? In acute pulmonary embolism that manifests as complete arterial occlusion, the affected artery may be enlarged. 2, American Journal of Roentgenology, Vol. (a) CT scan shows poor enhancement of the interlobar and middle lobe pulmonary arteries due to flow-related artifact. CT scan demonstrates pulmonary artery stump in situ thrombosis that affects the right pulmonary artery (arrow).Download as PowerPointOpen in Image More distally, the pulmonary arteries were well enhanced. Viewer. 43, No. These findings indicate the true nature of the patient’s condition.Download as PowerPointOpen in Image They may demonstrate vascular distention and local extravascular spread (,40). Note also the medium-sized left pleural effusion and atelectasis. Figure 12. CTPA is currently regarded as the reference standard for confirming the diagnosis of pulmonary embolism. Localized increase in vascular resistance in a 65-year-old man with dyspnea. A focal increase in vascular resistance can result from lung consolidation or atelectasis, is a cause of indeterminate CT pulmonary angiography, and can cause misdiagnosis of pulmonary embolism (,,,,,,Fig 35) (,35). Mucus plugs in an 83-year-old woman with dyspnea. Pulmonary embolism (PE) is a relatively common vascular disease with potentially life-threatening complications in the short term. 5, Journal of Cardiac Surgery, Vol. CT scans demonstrate normal hilar lymph nodes in both upper lobes (arrows in a), adjacent to the right and left interlobar arteries (arrows in b), in the middle lobe and lingula (arrows in c), and in both lower lobes (arrows in d).Download as PowerPointOpen in Image The vessels are seen as either normal, containing acute pulmonary embolism, containing chronic pulmonary embolism, or indeterminate. The following document is an updated CT protocol for all of the sites at which TRA-MINW is ... CTA Chest Pulmonary Embolism & Routine CT Abdomen + Pelvis W CTA Chest (pulmonary arterial) & CT Abdomen + Pelvis W (venous) Indication: Evaluate for pulmonary embolism (chest pain, shortness of breath, elevated D-dimer, etc.) Viewer. (d) Subsequent angiogram demonstrates slight distortion of the posterobasal segment of the left lower lobe pulmonary artery (arrow) but no evidence of pulmonary embolism. Such detection can help determine further imaging needs and allow the timely initiation of appropriate therapy. Figure 29. (b) CT scan (mediastinal window) demonstrates a low-attenuation abnormality caused by partial volume averaging of vessel and adjacent lung (arrow), a finding that can simulate pulmonary embolism. If findings in the pulmonary arteries are indeterminate and the lungs are clear, ventilation-perfusion scintigraphy may be performed. (e) More oblique angiogram of the left pulmonary artery also demonstrates no evidence of pulmonary embolism (arrow). Figure 7. Small pulmonary emboli are noted in the left pulmonary artery. Chronic pulmonary embolism in the same patient as in ,Figure 12. CT scan reveals that the short axis of the right ventricle (dashed line) is wider than that of the left ventricle (solid line), a situation that was caused by acute pulmonary embolism and created right ventricular strain.Download as PowerPointOpen in Image These CT findings include (a) right ventricular dilatation (in which the right ventricular cavity is wider than the left ventricular cavity in the short axis) (,Fig 9) (,19), with or without contrast material reflux into the hepatic veins; (b) deviation of the interventricular septum toward the left ventricle (,Fig 9) (,19); or (c) a pulmonary embolism index greater than 60% (,20). 188, No. A region-of-interest measurement may be helpful if the attenuation is greater than 78 HU (,28). Figure 30a. Streak artifact in a 35-year-old woman with chest pain. CT scan shows the vascular bifurcation between the left lower lobe and lingular arteries as a curved line surrounded by contrast material (arrow). Partial volume artifact in a 52-year-old woman with dyspnea. The specifics will vary depending on CT hardware and software, radiologists' and referrers' preference, institutional protocols, patient factors (e.g. Note also the fluid-filled, dilated esophagus. 3. 3, 19 March 2018 | Current Radiology Reports, Vol. 05, American Journal of Roentgenology, Vol. Viewer. These findings indicate the true nature of the patient’s condition.Download as PowerPointOpen in Image (b) CT scan produced with bone window settings clearly depicts the pulmonary artery catheter. Figure 9. Figure 25 illustrates the effect of different window settings on detection of pulmonary embolism. CT scan shows a large tumor embolus within the right lower lobe pulmonary artery (arrow).Download as PowerPointOpen in Image (b) CT scan (lung window) demonstrates the accompanying findings of diffuse peribronchovascular thickening, ground-glass attenuation, smooth interlobular septal thickening (arrows), and bilateral pleural effusions. 5, 1 January 2015 | Polish Journal of Radiology, Vol. Viewer. Viewer. In addition, a centrally located, hyperattenuating filling defect is occasionally identified at unenhanced CT, a finding that indicates acute central pulmonary embolism (,,, Fig 10) (, 22). 65, No. 81, No. Viewer, Figure 2. The radiologist needs to determine the quality of a CT pulmonary angiographic study and whether pulmonary embolism is present. Figure 11. The artifact can be recognized by its nonanatomic, radiating nature.Download as PowerPointOpen in Image Viewer. CTA Pulmonary Embolism CTA Chest (pulmonary angiogram) Reviewed By: Rachael Edwards, MD; Dan Verdini, MD; Brett Mollard, MD Last Reviewed: July 2019 Contact: (866) 761-4200, Option 1 In accordance with the ALARA principle, TRA policies and protocols promote the utilization of radiation dose reduction techniques for all CT examinations. 6, 10 October 2018 | Journal of Medical Imaging and Radiation Oncology, Vol. (c) Contiguous CT scan obtained immediately superior to a demonstrates a contrast material-filled pulmonary artery, a finding that confirms that the low attenuation seen in a was due to partial volume artifact.Download as PowerPointOpen in Image This finding is seen when viewed with mediastinal or pulmonary embolism-specific windows and manifests as a bright ring around pulmonary arteries, particularly if associated with a flow artifact. 8, The British Journal of Radiology, Vol. Esophagitis and, rarely, esophageal rupture may also be identified, as well as pneumonia, lung cancer, and pleural disease, including pneumothorax and pleuritis. Hilar lymph nodes in the lungs can be conveniently divided into upper lobe, interlobe, middle lobe (lingular), and lower lobe groups (,31,,32). 3, Journal of Thoracic Oncology, Vol. Coronal reformatted image of the right interlobar artery and the posterobasal segment of the pulmonary artery demonstrates dense contrast material superior and inferior to a region of poorly enhanced blood (arrow).Download as PowerPointOpen in Image Viewer. CT scans demonstrate normal hilar lymph nodes in both upper lobes (arrows in a), adjacent to the right and left interlobar arteries (arrows in b), in the middle lobe and lingula (arrows in c), and in both lower lobes (arrows in d). Figure 32. Figure 24a. 4, © 2021 Radiological Society of North America, EDUCATION EXHIBIT - Continuing Medical Education, Open in Image (a) CT scan shows a flow artifact caused by a localized increase in vascular resistance (arrow), a finding that can mimic acute pulmonary embolism. The dark regions of underperfused lung are seen to contain vessels (arrows) that are smaller than the adjacent patent vessels in the normally perfused lung.Download as PowerPointOpen in Image The criteria for in situ thrombus include (a) thrombus at the surgical site only (,Fig 36) and (b) the absence of other pulmonary artery thrombi remote from the stump site (,37). Viewer, Figure 3. Respiratory motion artifact in a 61-year-old man with dyspnea. Computed Tomography (CT) is the mainstay of diagnostic imaging evaluation of thoracic disorders. A total of 198 studies performed with four CM injection protocols varying in CM volume and iodine delivery rates (IDR) were retrospectively … Motion artifact renders the diagnosis of pulmonary embolism at this anatomic level indeterminate. Figure 40. Tumor emboli in a 60-year-old man with dyspnea and primary renal cell carcinoma. 118, No. Flow-related artifact in a 73-year-old woman with chest pain. 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