Massive Pulmonary Emboli and CT Pulmonary Angiography


Findik S., Erkan L., Light R. W., Uzun O., Atici A. G., Akan H.

RESPIRATION, vol.76, no.4, pp.403-412, 2008 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 76 Issue: 4
  • Publication Date: 2008
  • Doi Number: 10.1159/000147765
  • Journal Name: RESPIRATION
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.403-412
  • Keywords: CT pulmonary angiography, Venous thrombosis, Pulmonary embolism, Pulmonary artery, Right ventricular dysfunction, RIGHT-VENTRICULAR DYSFUNCTION, HELICAL COMPUTED-TOMOGRAPHY, SPIRAL CT, PLEURAL EFFUSIONS, DIAGNOSIS, THROMBOEMBOLISM, OBSTRUCTION, INFARCTION, INDEX
  • Ondokuz Mayıs University Affiliated: Yes

Abstract

Background: Massive pulmonary embolism (PE) is a devastating form of PE which usually results in acute right ventricular failure and death within 1-2 h. Objectives: To retrospectively assess pulmonary vascular, cardiac, pleural, and parenchymal findings on CT pulmonary angiography (CTPA) in patients with a diagnosis of massive PE (systolic blood pressure < 90 mm Hg, syncope and/or shock). Methods: In 33 consecutive patients with proven massive PE, hemodynamic severity was assessed by the extent of right ventricular dysfunction (RVD); diameter of the main pulmonary artery; the shape of the interventricular septum; and the extent of obstruction to the pulmonary arterial circulation (CT obstruction index). Results: Central pulmonary arteries were embolized in all patients. RVD was detected in all patients (94% of them had severe RVD); the diameter of the main pulmonary artery was wider than normal in 76% of the patients; the shape of the interventricular septum was abnormal in all patients, and the CT obstruction index was higher than or equal to 50% in 85% of the patients. Wedge-shaped pleural-based consolidation was the most common parenchymal abnormality (36%). Pleural effusions were seen in 26 patients (79%). Twenty-eight patients were alive, and only the use of thrombolytic therapy was found to be statistically significant. Conclusions: In patients with acute massive PE, embolization of the central pulmonary arteries, RVD and displacement of the interventricular septum are commonly seen with CTPA. A CT obstruction index of > 50% is commonly observed in massive PE. There was no association between CTPA findings and survival. Copyright (c) 2008 S. Karger AG, Basel