Chronic pulmonary embolism

Changed by Yuranga Weerakkody, 11 Oct 2014

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

Radiographic features

CTPA

~~Vascular~~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}
  - poststenotic 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~~arenchymal 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 considrations on a CTPA include ⁷:

perivascular pulmonary oedema
artefacts/interpretational errors
- motion: breathing artefact
- flow related artefact
- streak artefact
- misinterterpretation
  - due to incorrect window settings
  - misinterpretation of veins as arteries
pulmonary arterial catheter ⁷
intrinsic intraluminal tumour
- pulmonary arterial sarcoma

~~-<li>Vascular CT signs include:<ul>~~
+<li>vascular CT signs include:<ul>
~~-<li>calcified thrombus</li>~~
+<li>calcified thrombus - <a title="calcific pulmonary emboli" href="/articles/calcific-pulmonary-emboli">calcific pulmonary emboli</a>
+</li>
~~-<li>Parenchymal signs (often non-specific on their own):<ul>~~
+<li>arenchymal signs (often non-specific on their own):<ul>

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