Filling Defect, Pulmonary Artery



Filling Defect, Pulmonary Artery


Jeffrey P. Kanne, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Pulmonary Emboli


Less Common



  • Tumor Embolism


Rare but Important



  • Abnormal Tubes and Catheters


  • Pulmonary Artery Sarcoma


  • Air Embolism


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Bland thrombi, tumor thrombi, and pulmonary artery sarcoma can have similar imaging appearances


Helpful Clues for Common Diagnoses



  • Pulmonary Emboli



    • Acute pulmonary thromboembolism



      • Complete or partial filling defect


      • Peripheral consolidation and ground-glass opacity from pulmonary hemorrhage or infarct


      • Residual thrombus in right heart


      • Right ventricular dilation from right heart strain (indicator of worse prognosis)


    • Chronic pulmonary thromboembolic disease



      • Eccentric clot contiguous with arterial wall


      • Uncommonly calcify


      • Webs and stenoses with post-stenotic dilation


      • Mosaic pattern of attenuation


      • Bronchial artery hypertrophy


    • Methylmethacrylate emboli



      • High-attenuation filling defect in pulmonary artery


      • Cement in spine from vertebroplasty


Helpful Clues for Less Common Diagnoses



  • Tumor Embolism



    • Renal cell carcinoma, hepatocellular carcinoma, and carcinoma of breast, stomach, and prostate most common


    • Filling defect in central pulmonary arteries


    • Tumor thrombus in inferior vena cava suggestive


Helpful Clues for Rare Diagnoses



  • Abnormal Tubes and Catheters



    • Retained or embolized catheter


  • Pulmonary Artery Sarcoma



    • Vast majority arise in pulmonary valve or large pulmonary arteries


    • Large, lobulated, low-attenuation filling defect


    • Extension outside of vessel lumen


    • Enhancement on CT or MR or uptake on FDG PET/CT


  • Air Embolism



    • Frequently iatrogenic



      • Intravenous line placement or utilization


      • Barotrauma from positive-pressure ventilation


    • Scuba diving






Image Gallery









Axial CECT shows multiple acute pulmonary arterial filling defects image. Note dilation of the affected arteries. Focal atelectasis, hemorrhage, or infarct is present in the left lower lobe image.

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Aug 8, 2016 | Posted by in CARDIOLOGY | Comments Off on Filling Defect, Pulmonary Artery

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