Chronic pulmonary embolism

Case contributed by Dr. Silvia González-Gómez

Presentation

Chest pain. Important past medical history includes pulmonary thromboembolism diagnosed approximately four years prior.

Patient Data

Age: 60 years
Gender: Female
CT

Intraluminal filling defect forming an obtuse angle with the vessel wall. There are also webs in the opacified arteries. Collateral circulation, especially bronchial arteries, can be seen near the descending aorta. 

Collateral circulation in chronic pulmonary embolism

Annotated image

The development of collateral circulation, especially bronchial arteries, can be identified near the descending aorta (red circle).

Case Discussion

Chronic pulmonary embolism results from the incomplete resolution of acute pulmonary thromboembolism or from repeated episodes of pulmonary thromboembolism.

Clinical manifestations usually include chest pain, angina, hemoptysis, syncope, and palpitations.

Chronic thrombi tend to be in the periphery of the vessel and can be seen as a linear band, membranes, or as a filling defect within the vessel wall forming an obtuse angle. In chronic pulmonary embolism, central recanalization of the thrombus and collateral circulation (especially bronchial arteries) can be seen.

Co-author of this case: Dr. Bibiana Pinzon.

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