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Thrombotic and Nonthrombotic Pulmonary Arterial Embolism: Spectrum of Imaging Findings¹

¹ From the Department of Radiology and Center for Imaging Science (D.H., K.S.L., T.S.K., H.S.B.) and the Division of Pulmonary and Critical Care Medicine (H.K., O.J.K.), Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135–710, Korea; and the Department of Radiology, Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada (T.F., N.L.M.). Presented as an education exhibit at the 2002 RSNA scientific assembly. Received February 25, 2003; revision requested March 24 and received April 17; accepted April 21. Address correspondence to K.S.L. (e-mail: melon2@samsung.co.kr).

Along with clinical examination and laboratory tests, imaging plays a key role in the diagnosis of pulmonary embolism. Multi–detector row helical computed tomography (CT) is particularly helpful in the diagnosis of acute pulmonary thromboembolism (PTE) owing to its capacity to directly show emboli as intravascular filling defects. Although parenchymal abnormalities at CT are nonspecific for acute PTE, they may contribute to a correct diagnosis of chronic PTE, the characteristic helical CT features of which are similar to its angiographic features and include webs or bands, intimal irregularities, abrupt narrowing or complete obstruction of the pulmonary arteries, and "pouching defect." Nonthrombotic pulmonary embolism is an uncommon condition but is sometimes associated with specific imaging findings, including discrete nodules with cavitation (septic embolism), widespread homogeneous and heterogeneous areas of increased opacity or attenuation that typically appear 12–24 hours after trauma (fat embolism), and fine miliary nodules that subsequently coalesce into large areas of increased opacity or attenuation (talcosis). Knowledge of appropriate imaging methods and familiarity with the specific imaging features of pulmonary embolism should facilitate prompt, effective diagnosis.

© RSNA, 2003

Index Terms: Embolism, 60.72 • Embolism, fat, 60.724 • Embolism, oil • Embolism, pulmonary, 60.72 • Pulmonary arteries, CT, 944.1211 • Pulmonary arteries, thrombosis, 944.7229

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