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(Circulation. 2001;103:2993.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Three-Dimensional Visualization of Pulmonary Thromboemboli in Chronic Thromboembolic Pulmonary Hypertension With Multiple Detector-Row Spiral Computed Tomography

Dominik Fleischmann, MD; Christine Scholten, MD; Walter Klepetko, MD; Irene M. Lang, MD

From the Department of Radiology (D.F.), the Department of Internal Medicine II, Division of Cardiology (C.S., I.M.L.), and the Department of Surgery, Division of Cardiothoracic Surgery (W.K.), University of Vienna, Austria.

Correspondence to Irene M. Lang, MD, Department of Internal Medicine II, Division of Cardiology, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. E-mail irene.lang{at}univie.ac.at

A 36-year-old man experienced new-onset dyspnea on exertion. His previous medical history was unremarkable except for a motorcycle accident 16 years ago with multiple fractures of his right leg requiring surgery. Echocardiography showed severe right heart enlargement with impaired right ventricular function in the absence of intracardiac shunts or valvular heart disease. Venous duplex scanning demonstrated old organized thrombus in the right popliteal and femoral veins. Hemodynamic evaluation at rest disclosed pulmonary hypertension with a pulmonary vascular resistance of 600 dynes · s · cm^-5. Selective digital subtraction angiography showed irregular contours of the central pulmonary arteries, filling defects, and pruning of smaller, subsegmental arteries (Figure, A). Contrast medium–enhanced multiple detector-row (or multislice) spiral CT with 3D rendering clearly demonstrated the organized thromboembolic masses, thus confirming the diagnosis of chronic thromboembolic pulmonary hypertension (Figure, B). The patient underwent a successful bilateral pulmonary thromboendarterectomy, yielding 25 g of whitish-reddish, partly organized thromboembolus (Figure, C), with subsequent normalization of pulmonary hemodynamics and exercise capacity.

View larger version (93K): [in this window] [in a new window]   Figure 1. A, Selective digital subtraction angiography of the right pulmonary artery. The angiogram shows wall irregularities and filling defects (arrow) at the right lower lobe artery. Note that the thrombus itself is not visualized with digital subtraction angiography. Thus, the true size of the pulmonary artery is underestimated. B, CT angiography with 3D volume-rendered image with a cut plane through the right pulmonary artery. Contrast material–filled vessels (arteries and veins) are shown in yellow; thrombus is displayed in red. Note the extensive, wall-adherent thrombotic masses (arrow) within the right pulmonary artery. The white elliptical structure medial to the upper lobe artery represents the azygos vein. LA indicates left atrium. C, Surgical thromboendarterectomy specimen from the right pulmonary artery. Thrombus was harvested from the pulmonary artery as far distal as the subsegmental branches. The specimen represents endothelialized thrombus (arrow) with portions of fibroblast-rich organized thrombus parenchyma.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fleischmann, D. Articles by Lang, I. M. Search for Related Content PubMed PubMed Citation Articles by Fleischmann, D. Articles by Lang, I. M. Related Collections Cardiovascular imaging agents/Techniques Deep vein thrombosis Pulmonary circulation and disease CT and MRI