Chronic pulmonary embolism

Changed by Prashant Mudgal, 18 Oct 2016

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Chronic pulmonary emboli are mainly a consequence of incomplete resolution of pulmonary thromboembolism.

Radiographic features

CTPA

vascular CT signs include
- direct pulmonary artery signs
  - complete obstruction
  - partial obstruction
  - eccentric thrombus
  - calcified thrombus - calcific pulmonary emboli
  - pulmonary arterial bands/pulmonary arterial webs ^1,4-5
  - post stenotic dilatation
- signs related to pulmonary hypertension
  - enlargement of main pulmonary arteries
  - the peripheral pulmonary arteries in affected segments may be narrowed ^{ref required}
  - pulmonary arterial calcification
  - tortuous pulmonary vessels
  - right ventricular enlargement/hypertrophy
- signs of systemic collateral supply
  - enlargement of bronchial and nonbronchial systemic arteries
parenchymal signs (often non-specific on their own):
- scars
- mosaic perfusion pattern
- focal ground-glass opacities
- bronchial anomalies

Nuclear medicine: V/Q scan

Some publications suggest that V/Q scanning may be more sensitive than CTPA in detecting chronic pulmonary embolic burden ⁶.

Complications

Increased vascular resistance due to obstruction of the vascular bed leads to pulmonary hypertension.

Differential diagnosis

Differential considerations on a CTPA include ⁵:

perivascular pulmonary oedema
artefacts/interpretational errors
- motion: breathing artefact
- flow related artefact
- streak artefact
- misinterpretation
  - due to incorrect window settings
  - misinterpretation of veins as arteries
pulmonary arterial catheter ⁵
intrinsic intraluminal tumour
- pulmonary arterial sarcoma

-</ul><h5>Nuclear medicine: V/Q scan</h5><p>Some publications suggest that V/Q scanning may be more sensitive than CTPA in detecting chronic pulmonary embolic burden <sup>6</sup>.</p><h4>Complications</h4><p>Increased vascular resistance due to obstruction of the vascular bed leads to <a href="/articles/pulmonary-hypertension-1">pulmonary hypertension</a>.</p><h4>Differential diagnosis</h4><p>Differential considerations on a CTPA include <sup><span style="font-size:11px">5</span></sup>:</p><ul>
+</ul><h5>Nuclear medicine: V/Q scan</h5><p>Some publications suggest that V/Q scanning may be more sensitive than CTPA in detecting chronic pulmonary embolic burden <sup>6</sup>.</p><h4>Complications</h4><p>Increased vascular resistance due to obstruction of the vascular bed leads to <a href="/articles/pulmonary-hypertension-1">pulmonary hypertension</a>.</p><h4>Differential diagnosis</h4><p>Differential considerations on a CTPA include <sup>5</sup>:</p><ul>
~~-<li>pulmonary arterial catheter <sup><span style="font-size:11px">5</span></sup>~~
+<li>pulmonary arterial catheter <sup>5</sup>

Images Changes:

Image 1 CT (C+ arterial phase) ( create )

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