Presentation
Chest pain. Previous PE, stopped NOAG 2 weeks ago.
Patient Data
Good quality study. Nonocclusive filling defects within two segmental branches of the inferior lingula. No other PE. No evidence of right heart strain. RV/LV ratio is 1.0 (normal is <1.0).
Minor atelectasis within the superior left lower lobe adjacent to the oblique fissure. Bilateral posterior dependent changes. Otherwise the lungs are clear. Azygous fissure represents an anatomic variant. No pneumothorax or pleural effusion. Minor secretions within the trachea. No distal bronchial plugging.
Small hiatus hernia. Scattered coronary artery calcification. Otherwise normal heart and mediastinal structures. No enlarged lymph nodes.
The imaged upper abdominal organs are unremarkable. No destructive osseous lesions. Bifid right sixth rib.
IMPRESSION
Nonocclusive segmental inferior lingular pulmonary emboli. No evidence of right heart strain.
Case Discussion
Case example of positive CTPA with a dual-layer spectral CT:
- the low monoenergetic (monoE, 45 keV) recons are used to provide an iodine boost to the pulmonary arteries, good if there is suboptimal contrast opacification.
- the Z effective (Zeff) recons provides a map of perfusion which details the presence of contrast in the lung, good to identify perfusion defects that may be due to subtle PEs.
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