Demonstration of pulmonary embolism with dynamic gadolinium-enhanced spiral CT

The authors report a case of successful detection of pulmonary embolism usi ng gadolinium-enhanced spiral CT (Gadodiamide, 0.4 mmol/kg, 2 ml/s, delay 1 8 s) in a 77-year-old woman, with previous allergy to iodinated contrast me dium, and renal failure, who presented with pulmonary arterial hypertension . Doppler ultrasound of the lower limbs was first performed and revealed a deep venous thrombosis of the right lower limb. To establish if venous thro mbosis was the cause of pulmonary hypertension and to confirm that pulmonar y endarterectomy was not indicated in this situation, several imaging modal ities were performed. Lung scintigraphy and MRI were non-diagnostic. Gadoli nium-enhanced spiral CT demonstrated a large thrombus located proximally an d in a segmental artery of the right lower lobe. This case illustrates the potential usefulness of gadolinium as alternative contrast agent with spira l CT to diagnose pulmonary embolism and elucidate the cause of pulmonary ar terial hypertension in a patient with some contraindications for iodinated contrast medium injection.