Thrombotic and nonthrombotic pulmonary embolism


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Thrombotic and nonthrombotic pulmonary embolism

  1. 1. Thrombotic and Nonthrombotic Pulmonary Arterial Embolism By Gamal Rabie Agmy , MD , FCCP Professor of Chest Diseases ,Assiut University
  2. 2. Acute Pulmonary Embolism Saddle PE :that lodges at the bifurcation of the main pulmonary artery
  3. 3. Multidetector-CT Findings • Partial or complete filling defects in lumen of pulmonary arteries – Most reliable sign is filling defect forming acute angle with vessel wall with defect outlined by contrast material – “Tram-track sign” • Parallel lines of contrast surrounding thrombus in vessel that travels in transverse plane – “Rim sign” • Contrast surrounding thrombus in vessel that travels orthogonal to transverse plane • RV strain indicated by straightening or leftward bowing of interventricular septum Macdonald S; Mayo J. Semin. Ultrasound CT. 2003;24(4):271-231.
  4. 4. Large saddle thrombus with extensive clot burden. Arrows demonstrating tram-track sign (A), rim sign (B), complete filling defect (C), and a fully non-contrasted vessel (D)
  5. 5. Acute pulmonary embolism and deep venous thrombosis (DVT) in a 48-year-old woman. (a) Contrast material–enhanced pulmonary CT arteriogram (1.25-mm collimation) obtained at the level of the basal subsegmental pulmonary artery shows multifocal low-attenuation emboli (arrows) in segmental and subsegmental arteries in the right lower lobe. (b) Contrast-enhanced indirect CT venogram (5-mm collimation) obtained at the level of the pelvic inlet 3 minutes after injection shows large lowattenuation thrombi filling the left common iliac vein (arrow).
  6. 6. Acute pulmonary embolism in a 41-yearoldwoman. Coronal gadoliniumenhanced three-dimensional pulmonary MR angiogram shows a large embolus (arrows) in the proximal right interlobar artery.
  7. 7. Embolic burden scoring system. Schematic of the pulmonary arterial tree with scores for nonocclusive emboli according to vessel. Emboli in a segmental pulmonary artery are given a score of 1. Emboli in more proximal pulmonary arteries are given a score based on the total number of segmental pulmonary arteries supplied.
  8. 8. Helical CT Findings in Chronic PTE Cardiac abnormalities Right ventricular enlargement Right atrial enlargement Thrombi in the right atrium or ventricle* Vascular abnormalities Eccentric, flattened defect at an obtuse angle with the vessel wall* Irregular or nodular arterial wall Abrupt narrowing of the vessel diameter Abrupt cutoff of distal lobar or segmental artery Recanalization of thrombosed vessel Webs or bands (less frequent) Parenchymal abnormalities Bronchial artery dilatation Bronchiectasis Areas of decreased attenuation in the lung (mosaic perfusion pattern)
  9. 9. Septic Pulmonary Embolism Septic pulmonary embolism in a 28-year-old intravenous drug abuser with human immunodeficiency viral infection. Repeated blood cultures disclosed a positive culture for Nocardia. (a) Radiograph shows multiple cavitary nodules throughout both lungs. (b) CT scan (10-mm collimation) obtained at the level of the azygos arch demonstrates the feeding vessel sign (vessel leading directly to the nodule) in several nodules
  10. 10. Hydatid Embolism
  11. 11. Fat Embolism
  12. 12. Amniotic Fluid Embolism
  13. 13. Tumor Embolism
  14. 14. Air Embolism
  15. 15. Talc Embolism
  16. 16. Cement (Polymethylmethacrylate) Embolism
  17. 17. Iodinated oil embolism
  18. 18. Miscellaneous Foreign Body Embolism