E5107. Imaging of Acute Pulmonary Embolism: Pitfalls and Pearls
Authors
Livia Maria Frota Lima;
Mayo Clinic
Lara Walkoff;
Mayo Clinic
Background
Pulmonary embolism (PE) is a common, life-threatening medical condition affecting around 900,000 people in the U.S. every year, with 10–30% mortality within 1 month of diagnosis. CT pulmonary angiogram (CTPA) has significantly improved the detection of pulmonary embolism and is considered the imaging modality of choice for diagnosis.
Educational Goals / Teaching Points
Describe protocols for CTPA. Discuss various pitfalls encountered in CTPA performed in patients with suspected PE. Review different steps for troubleshooting artifacts and nondiagnostic exams.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
PE will present as a filling defect within the pulmonary arteries. Several technical and nontechnical aspects, including patient-related, may degrade the quality of a CTPA. Examples include patient’s body habitus, cardiac output, breathing, and other motion artifacts. Possible solutions to avoid these pitfalls include changing breathing instructions, scanner mode, and timing. Potential pitfalls and artifacts that can mimic PE include slow flow due to surrounding parenchymal pathology, tumor emboli, and endobronchial debris.
Conclusion
Emergency radiology plays an important role in the rapid and accurate diagnosis of PE. Awareness of potential pitfalls and solutions to overcome these pitfalls are essential to achieve optimal diagnostic quality CTPAs and to avoid misdiagnosis.
