Demonstration of Massive Pulmonary Embolism With Spiral Volumetric CT
The diagnosis of pulmonary embolism is still a challenge for clinicians because of its nonspecific and variable clinical features and the suboptimal accuracy of the noninvasive diagnostic tools. Even the ventilation-perfusion scanning, which currently represents the primary screening examination, is diagnostic only when negative or high probability. Thus, alternative imaging techniques are needed for the noninvasive diagnosis of pulmonary embolism.
Spiral volumetric CT, enhanced by the intravenous injection of contrast medium, appears to be very promising in this clinical setting, having showed a sensitivity and a specificity of 100% and 96%, respectively, compared with pulmonary angiography.1
This image was taken in a 74-year-old woman with obesity, hypertension, and a history of previous thrombophlebitis who had been complaining of dyspnea for several days before admission and who was referred by the Emergency Department to the Coronary Care Unit for mild hemodynamic deterioration. A large thromboembolus occupying the lumen of the right main and left descending pulmonary arteries is clearly evident.
The patient was immediately treated with intravenous heparin and inotropic support, which induced a rapid improvement of the clinical and hemodynamic parameters. She was discharged 3 weeks later on warfarin, ACE inhibitors, and calcium antagonists.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.
- Copyright © 1997 by American Heart Association