Arterial phase left atrial opacification in acute massive pulmonary embolism.
Classic angiographic features in acute massive pulmonary embolism include main or lobar arterial branch cut-off, and/or arterial filling defects with matching impaired venous drainage. Six haemodynamically compromised patients with acute massive pulmonary embolism (mean pulmonary artery pressure 55 +/- 12 mmHg), confirmed by pulmonary arteriography, are described. Early opacification of the left atrium during the arterial phase of the pulmonary angiogram was seen in all patients. Follow-up pulmonary arteriography after successful thrombolytic therapy was performed 4 days later in 2 cases. A marked haemodynamic improvement was accompanied by resolution of the previous abnormal angiographic signs, including early opacification of the left atrium. The latter might be a response to intensive reactive vasodilatation of the remaining perfused lung fields resulting in a more rapid pulmonary transit time and the opening of arteriovenous channels with further systemic desaturation. This angiographic sign is a marker of severe, but reversible, vasoconstriction in acute massive pulmonary embolism.
Department of Cardiology, Baragwanath Hospital, Johannesburg.
S J
SJ
Middlemost
M R
MR
Essop
J S
JS
Skoularigis
T W
TW
Wisenbaugh
P
P
Sareli
D000208:Acute Disease; D000328:Adult; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000175:diagnosis*; D011859:Radiography