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Pulmonary Embolism

What's Wrong with This Diagnosis?

¹ Department of Radiology, Rm. 1502, Duke University Medical Center, Erwin Rd., Durham, NC 27710.

View larger version (102K): [in a new window]   Percy Brown 12th President of ARRS 1911-1912

View larger version (141K): [in a new window]   (Courtesy of the American College of Radiology) Frederick H. Baetjer 13th President of ARRS 1912-1913

View larger version (141K): [in a new window]   Fig. 1A. —77-year-old man found unresponsive. Frontal chest radiograph reveals marked paucity of pulmonary vasculature to right lung base.

View larger version (100K): [in a new window]   Fig. 1B. —77-year-old man found unresponsive. Enhanced helical CT chest scan reveals marked intraluminal filling defect involving right pulmonary artery (black arrowhead) and extending into interlobar artery (white arrowhead), representing extensive pulmonary embolism. (Courtesy of McAdams HP, Durham, NC)

View larger version (113K): [in a new window]   Fig. 2A. —63-year-old man with dyspnea for 24 hr. Chest radiograph revealed loss of volume in middle and lower lobes and small right pleural effusion. Left lung was normal. Perfusion lung scintigram reveals perfusion defect in right lung base (solid arrow) and smaller defect in left lung base (open arrow).

View larger version (119K): [in a new window]   Fig. 2B. —63-year-old man with dyspnea for 24 hr. Chest radiograph revealed loss of volume in middle and lower lobes and small right pleural effusion. Left lung was normal. Ventilation lung scintigram shows defects that are matched to perfusion abnormalities and delayed washout in left lung base (arrow). This study was given intermediate probability for pulmonary embolism on basis of PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) criteria. (Courtesy of Coleman RE, Durham, NC)

View larger version (143K): [in a new window]   Fig. 2C. —63-year-old man with dyspnea for 24 hr. Chest radiograph revealed loss of volume in middle and lower lobes and small right pleural effusion. Left lung was normal. Selective right pulmonary artery angiogram reveals decreased flow to right lung base (arrows) that correlates well with findings on scintigraphy. No evidence of pulmonary embolism is seen.

View larger version (146K): [in a new window]   Fig. 2D. —63-year-old man with dyspnea for 24 hr. Chest radiograph revealed loss of volume in middle and lower lobes and small right pleural effusion. Left lung was normal. Selective left pulmonary angiogram reveals intraluminal filling defects in branches to left lower lobe (arrows), representing acute pulmonary embolism.

View larger version (101K): [in a new window]   Fig. 3A. —59-year-old man with history of metastatic lung and renal carcinoma and deep venous thrombosis involving both lower limbs who presented with dyspnea, cough, and low-grade fever. Helical CT chest scan reveals extensive intraluminal filling defects in both pulmonary arteries (arrows), which is diagnostic of pulmonary embolism.

View larger version (86K): [in a new window]   Fig. 3B. —59-year-old man with history of metastatic lung and renal carcinoma and deep venous thrombosis involving both lower limbs who presented with dyspnea, cough, and low-grade fever. Lower sections of helical CT chest scan reveal thrombus extending into segmental and subsegmental branches (arrows). (Courtesy of Erasmus JJ, Durham, NC)

View larger version (113K): [in a new window]   Fig. 4. —58-year-old man with deep venous thrombosis seen on MR venography. During same sitting, contrast-enhanced axial gradient-recalled echo MR pulmonary angiogram was obtained and reveals absence of signal in main pulmonary artery extending into right pulmonary artery, which is diagnostic of pulmonary embolism (arrowheads). (Courtesy of Spritzer CE, Durham, NC)

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