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(Circulation. 2009;119:3242-3243.)
© 2009 American Heart Association, Inc.

Images in Cardiovascular Medicine

Lung Perfusion Blood Volume Computed Tomographic Images of Pulmonary Embolism

Before and After Thrombolysis

Eijun Sueyoshi, MD; Shin Tsutsui, MD; Ichiro Sakamoto, MD; Masataka Uetani, MD; Koji Maemura, MD

From the Department of Radiology and Cardiology, Nagasaki University School of Medicine, Nagasaki, Japan.

Correspondence to Eijun Sueyoshi, MD, Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. E-mail EijunSueyoshi@aol.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 43-year-old woman was admitted with right leg edema and pain. She had previously been prescribed low-dose oral contraceptive pills for dysmenorrhea associated with endometriosis for 2 years. Thromboses in the right superficial femoral vein were seen on venous Doppler ultrasound examination. At that time, there were no signs and symptoms of pulmonary embolism. For pulmonary embolism screening, computed tomographic (CT) study with the use of a dual-energy CT scanner (Somatom Definition scanner, Siemens Medical Systems, Forchheim, Germany) was performed in dual-energy mode. Contrast-enhanced CT images of the chest showed low-attenuation filling defects in the segmental pulmonary arteries (Figure 1). The lung perfusion blood volume (PBV) CT image showed the wedge-shaped low-attenuation areas in right middle and lower lobes (Figure 2). In the low-attenuation area of the right lower lobe, a region of interest was placed to measure parenchymal enhancement of the lung, and CT attenuation value was 36.2 Hounsfield units. In the opposite site, CT attenuation value was 73.3 Hounsfield units. The low-attenuation areas suggested reduced pulmonary perfusion. The diagnosis of pulmonary embolism was made, and the patient was empirically anticoagulated with intravenous heparin.

View larger version (52K):   Figure 1. A, Contrast-enhanced CT images of the chest showed low-attenuation filling defects in the segmental pulmonary artery of the right middle lobe (arrow). B, Filling defects in the segmental pulmonary artery of the left lower lobe were also seen (arrow).

View larger version (50K):   Figure 2. A, Lung PBV CT image showed wedge-shaped low-attenuation areas in the right middle and lower lobes (arrows). B, . . . [Full Text of this Article]