DETECTION OF UNSUSPECTED CENTRAL PULMONARY-EMBOLISM WITH CONVENTIONALCONTRAST-ENHANCED CT

When fast, nondynamic scanning techniques are used in combination with adequate intravenous injection of contrast material, good-quality ima ges of the pulmonary artery (PA) can be obtained with routine computed tomography (CT). The purpose of this study was to evaluate PA filling defects detected on these CT scans. Twenty-two CT scans from 22 patie nts with PA filling defects were reviewed. A routine scanning techniqu e was used. Thrombus was unilateral in 12 cases and bilateral in 10. A ll patients but one had a predisposition for pulmonary embolism (PE). However, only five patients underwent CT because there was a strong su spicion for PE. In 17 cases, PE was not the first choice of clinical d iagnosis; in 13 cases, thrombus of the PA was not even considered. Dia gnosis was confirmed in 11 patients with ventilation-perfusion scannin g (n = 7), angiography (n = 3), and surgery (n = 1). In 11 patients, a nticoagulation therapy was started without further diagnostic procedur es. Diagnosis of thrombus of the PA is possible with routine nondynami c, contrast material-enhanced CT. Because PE is often unsuspected at c linical examination, every contrast-enhanced CT scan of the chest shou ld be evaluated for the presence of filling defects in the PA.