Massive pulmonary emboli and CT pulmonary angiography.
BACKGROUND
Massive pulmonary embolism (PE) is a devastating form of PE which usually results in acute right ventricular failure and death within 1-2 h.


OBJECTIVE
To retrospectively assess pulmonary vascular, cardiac, pleural, and parenchymal findings on CT pulmonary angiography (CTPA) in patients with a diagnosis of massive PE (systolic blood pressure <90 mm Hg, syncope and/or shock).


METHODS
In 33 consecutive patients with proven massive PE, hemodynamic severity was assessed by the extent of right ventricular dysfunction (RVD); diameter of the main pulmonary artery; the shape of the interventricular septum; and the extent of obstruction to the pulmonary arterial circulation (CT obstruction index).


RESULTS
Central pulmonary arteries were embolized in all patients. RVD was detected in all patients (94% of them had severe RVD); the diameter of the main pulmonary artery was wider than normal in 76% of the patients; the shape of the interventricular septum was abnormal in all patients, and the CT obstruction index was higher than or equal to 50% in 85% of the patients. Wedge-shaped pleural-based consolidation was the most common parenchymal abnormality (36%). Pleural effusions were seen in 26 patients (79%). Twenty-eight patients were alive, and only the use of thrombolytic therapy was found to be statistically significant.


CONCLUSIONS
In patients with acute massive PE, embolization of the central pulmonary arteries, RVD and displacement of the interventricular septum are commonly seen with CTPA. A CT obstruction index of >50% is commonly observed in massive PE. There was no association between CTPA findings and survival.
Findik
Serhat
S
Department of Pulmonary Medicine, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey. serhatfindik1@yahoo.com
Erkan
Levent
L
Light
Richard W
RW
Uzun
Oguz
O
Atici
Atilla G
AG
Akan
Huseyin
H
D000368:Aged; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000209:etiology; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology; D054088:Ventricular Septum / Q000000981:diagnostic imaging*