Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Rizk M, Elfeky M, et al. Chronic pulmonary embolism. Reference article, Radiopaedia.org (Accessed on 19 Feb 2025) https://doi.org/10.53347/rID-25000
Chronic pulmonary emboli are mainly a consequence of incomplete resolution of pulmonary thromboembolism.
CTPA
- vascular CT signs include
- direct pulmonary artery signs
- signs related to pulmonary hypertension
- signs of systemic collateral supply
- enlargement of bronchial and non-bronchial systemic arteries 7,8
- parenchymal signs (often non-specific on their own):
Nuclear medicine: V/Q scan
Some publications suggest that V/Q scanning may be more sensitive 6,9 but less specific 9 than CTPA in detecting chronic pulmonary embolic burden.
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Increased vascular resistance due to obstruction of the vascular bed leads to pulmonary hypertension.
Differential considerations on a CTPA include 5:
- perivascular pulmonary edema
-
artifacts/interpretational errors
- motion: breathing artifact
- flow-related artifact
- streak artifact
- misinterpretation
- due to incorrect window settings
- misinterpretation of veins as arteries
-
pulmonary arterial catheter 5
- intrinsic intraluminal tumor
-
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7. Martine Remy-Jardin, Alain Duhamel, Valérie Deken, Nébil Bouaziz, Philippe Dumont, Jacques Remy. Systemic Collateral Supply in Patients with Chronic Thromboembolic and Primary Pulmonary Hypertension: Assessment with Multi–Detector Row Helical CT Angiography1. (2005) Radiology. 235 (1): 274-81. doi:10.1148/radiol.2351040335 - Pubmed
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8. Shyamal Madhavani, Edison Gavilanes, Helaine Larsen, Brian Webber. Pulmonary Collateral Circulation in Recurrent Pulmonary Thromboembolic Disease. (2017) CHEST. 152 (4): A1025. doi:10.1016/j.chest.2017.08.1058
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9. Meng Wang, Dayong Wu, Rongzheng Ma, Zongyao Zhang, Hailong Zhang, Kai Han, Changming Xiong, Lei Wang, Wei Fang. Comparison of V/Q SPECT and CT Angiography for the Diagnosis of Chronic Thromboembolic Pulmonary Hypertension. (2020) Radiology. doi:10.1148/radiol.2020192181 - Pubmed
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10. Nishiyama KH, Saboo SS, Tanabe Y, Jasinowodolinski D, Landay MJ, Kay FU. Chronic pulmonary embolism: diagnosis. (2018) Cardiovascular diagnosis and therapy. 8 (3): 253-271. doi:10.21037/cdt.2018.01.09 - Pubmed
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