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Prof. Mona Mansour Professor of Pulmonary Medicine Ain Shams University

Imaging of Pulmonary Embolism. BY. Prof. Mona Mansour Professor of Pulmonary Medicine Ain Shams University.

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Prof. Mona Mansour Professor of Pulmonary Medicine Ain Shams University

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  1. Imaging of Pulmonary Embolism BY Prof. Mona MansourProfessor of Pulmonary Medicine Ain Shams University

  2. Pulmonary embolism refers to embolic occlusion of the pulmonary arterial system. The majority of cases result from thrombotic occlusion and therefore the condition is frequently termed pulmonary thrombo-embolism

  3. Diagnosis Pulmonary embolism may be difficult because no reliable non invasive imaging method. • In United States: estimated incidence of PE exceeds 600.000 cases per year. • 30% mortality if untreated. • Mortality in treated cases 2.5%

  4. 1- Clinical assessment: • Wells score • Geneva score

  5. 2- Serological tests: • D Dimer (ELISA) • Screening test in patients with low and moderate probability clinical assessment a. Normal D-Dimer has almost 100% negative predictive value b. Raised D-Dimer is non specific: we need further investigation

  6. 3- Radiological features: Plain film: Fleishner sign: Enlarged pulm. Artery (20%) Hampton hump: Perpheral wedge of air space opacity implies lung infarction (20%) Westermark sign: Regional oligaemia (10%) Pleural effusion: 35% Elevated diaphragm:

  7. Nuclear medicine V/Q scan: • High probability scan is defined as two or more unmatched segmental perfusion defects. • Normal perfusion scan is very safe for excluding PE. • Combination of non diagnostic V/Q scan + low clinical probability can exclude PE.

  8. Computed Tomography with Pulmonary Angiography (CTPA): • Acute pulmonary embolism: • Filling defect (polo mint) sign. • Central filling defect from thrombus surrounded by a thin rim of contrast. • Saddle embolus

  9. Computed Tomography with Pulmonary Angiography (CTPA): • Chronic pulmonary embolism: • Webs or bands • Abrupt narrowing or complete obstruction of pulmonary arteries

  10. Computed Tomography with Pulmonary Angiography (CTPA): • Acute or Chronic right ventricular dysfunction: a- Abnormal position of interventricular septum b- RVD: LVD ratio > 1

  11. Computed Tomography with Pulmonary Angiography (CTPA): • Subacute to Chronic emboli: a- Pulmonary infarction B- Pulmonary hypertension C- Chronic cor pulmonale

  12. Gadolinium Enhanced Pulmonary MagneticResonance Angiography (MRI): • Pulmonary arterial signs in MRA: a- abrupt decrease B- parenchymal sign C- pulmonary hypertension The use of MR venography could also help diagnosis of PE

  13. MRI is more expensive than VQ scan, but cheaper than angiography. • MRI does not require hospitalization • Non nephrotoxic • No ionizing radiation • Safe rapid, accurate, cost effective imaging.

  14. Compression Ultrasonography (CUS) • Diagnosis of DVT may indirectly suggest the diagnosis of PE • Anticoagulants are most often the initial therapy for DVT and PE

  15. Limitations: • Not Definite for PE • Normal proximal bilateral venous ultrasonography don't rule out PE

  16. Pulmonary angiography: • Invasive • CT angiography offers better results, non invasive

  17. Echo cardiography: • In shock or hypotension, absence of echo signs of Rt. over load or dysfunction excludes PE.

  18. Thank You

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