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60-year-old patient with known deep vein thrombosis in the right lower limb developed shortness of breath.

Pulmonary CT Angiography was done.

Axial CECT image at the level of the Main Pulmonary Trunk, the Right and Left Pulmonary arteries shows acute thrombois in the distal Right and Left Pulmonary arteries at the hilum level.

Coronal Maximal Intensity Projection (MIP) image shows acute thrombosis in the distal right and left Pulmonary arteries with extension predominantly into their inferior Lobar & Segmental and Subsegmental branches. Partial thrombosis is also seen in the superior Lobar and a few of their Segmental branches on both sides (first image below). A MIP image of the normal Pulmonary arterial tree is shown below for comparison (second image below).

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Sagittal MIP images of the left and right Pulmonary arteries…

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Diagnosis: Acute Pulmonary Embolism.

Recent advances in CT technology with the introduction of MDCT scanners allow faster scanning of larger volumes at thin collimation, improving both the visualization of segmental and subsegmental pulmonary arteries and increasing interobserver agreement about the presence or absence of emboli. The technique has several advantages over V/Q scintigraphy and pulmonary angiography. A properly performed and interpreted MDCT angiogram is almost always definitive for the diagnosis or exclusion of PE. Normal findings correlate with a low risk of subsequent PE, and, in most patients without embolism, MDCT can provide an alternative explanation for the symptoms.¹

Suggested Reading:

1. Attili AK. Diagnosis of pulmonary embolism with multidetector computed tomography. Online supplement to Applied Radiology September 2004 issue. [Full text; Subscription Required; Free]
2. Remy-Jardin M, Remy J. Spiral CT Angiography of the Pulmonary Circulation. Radiology 1999; 212:615-636 [Free full text]
3. Goldhaber SZ. Multislice Computed Tomography for Pulmonary Embolism — A Technological Marvel. N Engl J Med 2005; 352;17: 1812-1814 [Extract. Subscription Required for Full text]

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