ACUTE RIGHT-VENTRICULAR DILATATION - A NEW HELICAL CT SIGN OF MASSIVEPULMONARY-EMBOLISM

Acute right heart failure is a principal cause of circulatory collapse and death in patients with massive pulmonary embolism (PE), The purpo se of this study was to investigate if helical computed tomography (CT ) could contribute to the assessment of the right ventricle (RV) in th ose with massive PE, Over an 8-month period 79 helical CT pulmonary an giograms were performed to investigate suspected PE, Emboli were demon strated in 28 (35%) patients and seven (9%) were considered to have ha d a major thromboembolic event. The CT scans of all patients were eval uated using parameters derived in the axial plane (maximum minor axis RV and LV dimensions, RV:LV minor axis ratio and RV wall thickness). A cute right ventricular dilatation with an RV:LV ratio>1.5:1 (range 1.6 :1-2.3:1, mean 2:1) was found in all seven patients who had sustained major PE, In the remaining group of 21 with lesser degrees of embolism no patient had an RV:LV ratio > 1.1:1 (range 0.8-1.1, mean 1.0), To o ur knowledge, this CT sign has not been described before, Conclusion: Helical CT can identify acute RV dilatation in addition to making the primary diagnosis in patients with massive PE. This observation may he lp identify those at greatest risk of a second fatal event and facilit ate therapeutic strategy.