Pulmonary Embolism: Much Beyond Deep Venous Thrombosis Embolization

Congress:

ECR 2020

Poster Number:

C-04154

Type:

Educational Exhibit

Keywords:

Chest, Emergency, Lung, Pulmonary vessels, Conventional radiography, CT, CT-Angiography, Diagnostic procedure, Acute, Embolism / Thrombosis, Not applicable, Performed at one institution

Authors:

R. S. O. D. P. Furtado¹, H. Shoji², E. K. U. N. Fonseca², A. I. Gomes³, R. B. D. Passos⁴, W. Y. Ishikawa⁵, R. CHATE¹, G. SZARF⁴, M. B. D. G. Funari¹; ¹São Paulo, SP/BR, ²Sao Paulo/BR, ³Sao Paulo, Sao Paulo/BR, ⁴SÃO PAULO/BR, ⁵São Paulo, São paulo/BR

DOI:

10.26044/ecr2020/C-04154

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-04154

Fig. 1: Chest X-ray findings

Fig. 2: Chest X-ray findings

Fig. 3: Unenhanced chest CT findings

Fig. 4: Massive pulmonary embolism

Learning objectives

Sum up imaging findings of pulmonary thromboembolism (PE). Review the classic as well as atypical forms of PE. Highlight PE findings on chest X-rays (CXR) and non-enhanced computed tomography (NECT), as well as alarm signals for hemodynamic repercussion and atypical embolism.

Background

Computed tomography angiography (CTA) is the gold standard for the diagnosis of PE. However, this condition should be suspected even in conventional CXR as well as thoracoabdominal transition images and NECT. Alarm signals for hemodynamic instability should be recognized. It is also essential to remember atypical causes of PE that do not respond to anticoagulation.

Findings and procedure details

PE presentation is quite variable, ranging from asymptomatic to acute hemodynamic instability. The traditional pathophysiology is the migration of a thrombus, mainly from the lower limbs. However, other substances may also obstruct pulmonary arteries. The arterial obstruction will cause pulmonary parenchyma ischemia, intrapulmonary shunting, with associated gas exchange impairment and pulmonary vascular resistance increase (both directly by the mechanic obstruction and by the dynamic pulmonary vasoconstriction from hypoxia) that may affect the cardiac output. The hemodynamic compromise is quite variable and dependent on the thrombus...

Conclusion

Pulmonary thromboembolism is a severe and very incident disease, being presentrecurrently in the routine of every radiologist working in the emergency environment. Thus, the knowledge of its different presentations in the various imaging modalities isextremely important in the practice of the radiologist.

Personal information and conflict of interest

R. S. O. D. P. Furtado; São Paulo, SP/BR - nothing to disclose H. Shoji; São Paulo, SÃO PAULO/BR - nothing to disclose E. K. U. N. Fonseca; São Paulo, SÃO PAULO/BR - nothing to disclose A. I. Gomes; Sao Paulo, SAO PAULO/BR - nothing to disclose R. Passos; São Paulo, SP/BR - nothing to disclose W. Y. Ishikawa; São Paulo, SÃO PAULO/BR - nothing to disclose R. Chate; São Paulo, SP/BR - nothing to disclose G. Szarf; São Paulo/BR - nothing to disclose M....

References

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