Multislice computed tomography of pulmonary embolism: spectrum of findings

Background. The purpose of this study is to analyse the contribution of multislice computed tomography (MSCT) as a diagnostic method in the diagnosis of pulmonary embolism (PE) and spectrum of findings in our material. Methods. During the period of one and a half year, we found PE in 25 patients (15 males and 10 females). The average age of the patients was 54.4 years (25 - 74). The examination was performed by »Somatom Volume Zoom« Siemens CT machine with four row detectors, with retrospective ECG gating, collimation 4 x 2.5 mm and reconstructed section with 0.8 mm. Contrast medium (130 ml) and 10 ml of saline was applied, administered with a flow rate of 3.5 ml/s and with time delay of 22 seconds. Results. During the examination, we found embolism of the main branches of pulmonary artery in 14 (56%) patients, at the right branch in 10 (40%), at the left one in 4 (16%), and bilateral pulmonary embolism in 11 (44%) patients. Subsegmental pulmonary emboli were noticed in 8 (32%) patients. Pulmonary infarct was found in 12 (48%) patients, and was followed up with ipsilateral pulmonary artery dilatation in 11 (44%) cases, redistribution of the circulation and pulmonary artery branches dilatation in infarct zone in 9 (36%) cases, contrast enhanced consolidation of pulmonary parenchyma in 10 (40%), rag zones of ground glass attenuation in 15 (60%), haemorrhage in 21 (84%), striped and reticular pulmonary drawing in 11 (44%), and mosaic olighemy in 3 (12%)cases. Thrombi were rare, found only in the R/L atrium in 2 (8%)cases, pericardial haemorrhage in 1 (4%), mediastinal lymph nodes in 1(4%) case, sudden cut off of peripheral branch leading to infarct apex in 1 (4%), and haemoptysis in 1 (4%) case. In addition to deep vein thrombosis, heart failure was found as aetiology factor in 7 (28%) and malignancy in 3 (12%) cases. Conclusions. MSCT is an excellent non-invasive method for visualization of thrombus in the pulmonary artery. In our study, we have more often found embolism of the right branch of pulmonary artery, and pleural effusion, infarct contrast enhanced consolidation of pulmonary parenchyma, ground glass attenuation zone, ipsilateral pulmonary artery dilatation, circulation redistribution with pulmonary artery branches dilatation nearby infarct zone. This diversity of findings cannot be noticed by any other method, with the possibility of making alternative diagnosis, which has led MSCT in the foreground when pulmonary embolism diagnostics is at stake.