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Singapore Med J 2014; 55(5): 281-286; http://dx.doi.org/10.11622/smedj.2014073
Clinics in diagnostic imaging (152)
Bosco JI, Khoo RN, Peh WC
Correspondence: Prof Wilfred CG Peh, wilfred.peh@gmail.com
ABSTRACT
A 56-year-old man presented to the Accident and Emergency Department with pleuritic chest pain of sudden onset. He gave a history of short-distance air travel ten days earlier. Chest radiograph showed a peripheral-based opacity in the right lower zone, which was not seen in a previous study done three months ago, suggestive of Hampton’s hump. The D-dimer level was raised. Computed tomography pulmonary angiography confirmed the diagnosis of pulmonary embolism in a right lower lobe segmental branch, with adjacent collapsed lung, consistent with lung infarction. The patient was started on heparin injection with significant relief of his symptoms. The clinical and imaging features of pulmonary embolism are described, with emphasis on the historical radiographic signs and the current dualenergy computed tomography innovations.
Keywords: computed tomography pulmonary angiography, dual-energy computed tomography, Hampton’s hump, pulmonary embolism, venous thromboembolism
Singapore Med J 2014; 55(5): 281-286; http://dx.doi.org/10.11622/smedj.2014073
REFERENCES
| 1. Blann AD, Lip GY. Venous thromboembolism. BMJ 2006; 332:215-9. http://dx.doi.org/10.1136/bmj.332.7535.215 | ||||
| 2. Robinson GV. Pulmonary embolism in hospital practice. BMJ 2006; 332:156-60. http://dx.doi.org/10.1136/bmj.332.7534.156 | ||||
| 3. Kucher N, Rossi E, De Rosa M, and Goldhaber SZ. Massive pulmonary embolism. Circulation 2006; 113:577-82. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.592592 | ||||
| 4. Moser KM, Fedullo PF, LittleJohn JK, Crawford R. Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis. JAMA 1994; 271:223-5. http://dx.doi.org/10.1001/jama.1994.03510270069042 | ||||
| 5. Goldhaber SZ, Grodstein F, Stampfer MJ, et al. A prospective study of risk factors for pulmonary embolism in women. JAMA 1997; 277:642-5. http://dx.doi.org/10.1001/jama.1997.03540320044033 | ||||
| 6. Bartholomew JR, Schaffer JL, McCormick GF. Air travel and venous thromboembolism: minimizing the risk. Cleve Clin J Med 2011; 78:111-20. http://dx.doi.org/10.3949/ccjm.78a.10138 | ||||
| 7. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 8th ed. Chest 2008; 133 (Suppl 6):381S-453S. | ||||
| 8. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003; 58:470-83. http://dx.doi.org/10.1136/thorax.58.6.470 | ||||
| 9. Stein PD, Woodard PK, Weg JG, et al. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators. Radiology 2007; 242:15-21. http://dx.doi.org/10.1148/radiol.2421060971 | ||||
| 10. Stein PD, Henry JW. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest 1995; 108:978-81. http://dx.doi.org/10.1378/chest.108.4.978 | ||||
| 11. Nazaroglu H, Ozmen CA, Akay HO, Kilinç I, Bilici A. 64-MDCT pulmonary angiography and CT venography in the diagnosis of thromboembolic disease. Am J Roentgenol 2009; 192:654-61. http://dx.doi.org/10.2214/AJR.07.3939 | ||||
| 12. Wittram C, Maher MM, Yoo AJ, et al. CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics 2004; 24:1219-38. http://dx.doi.org/10.1148/rg.245045008 | ||||
| 13. Thieme SF, Johnson TR, Reiser MF, Nikolaou K. Dual-energy lung perfusion computed tomography: a novel pulmonary functional imaging method. Semin Ultrasound CT MR 2010; 31:301-8. http://dx.doi.org/10.1053/j.sult.2010.05.001 | ||||
| 14. Thieme SF, Ashoori N, Bamberg F, et al. Severity assessment of pulmonary embolism using dual energy CT - correlation of a pulmonary perfusion defect score with clinical and morphological parameters of blood oxygenation and right ventricular failure. Eur Radiol 2012; 22:269-78. http://dx.doi.org/10.1007/s00330-011-2267-3 | ||||
| 15. Zhang LJ, Zhao YE, Wu SY, et al. Pulmonary embolism detection with dual-energy CT: experimental study of dual-source CT in rabbits. Radiology 2009; 252:61-70. http://dx.doi.org/10.1148/radiol.2521081682 | ||||
| 16. Godoy MCB, Heller SL, Naidich DP, et al. Dual-energy MDCT: comparison of pulmonary artery enhancement on dedicated CT pulmonary angiography, routine and low contrast volume studies, Eur J Radiol 2011; 79:e11-7. http://dx.doi.org/10.1016/j.ejrad.2009.12.030 | ||||
| 17. Suh JM, Cronan JJ, Healey TT. Dots are not clots: the over-diagnosis and over-treatment of PE. Emerg Radiol 2010; 17:347-52. http://dx.doi.org/10.1007/s10140-010-0863-1 | ||||
| 18. Kluge A, Luboldt W, Bachmann G. Acute pulmonary embolism to the subsegmental level: diagnostic accuracy of three MRI techniques compared with 16-MDCT. AJR Am J Roentgenol 2006; 187:W7-14. http://dx.doi.org/10.2214/AJR.04.1814 | ||||
| 19. Sostman HD, Stein PD, Gottschalk A, et al. Acute pulmonary embolism: sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study. Radiology 2008; 246:941-6. http://dx.doi.org/10.1148/radiol.2463070270 | ||||
| 20. Hampton AO, Castleman B. Correlation of postmortem chest teleroentgenograms with autopsy findings with special reference to pulmonary embolism and infarction. Am J Roentgenol Radium Ther 1940; 43:305-26. | ||||
| 21. Westermark N. On the roentgen diagnosis of lung embolism. Acta Radiol 1938; 19:357-72. http://dx.doi.org/10.3109/00016923809137770 | ||||
| 22. Ho M, Gutierrez F. Chest radiography in thoracic polytrauma. AJR Am J Roentgenol 2009; 192:599-612. http://dx.doi.org/10.2214/AJR.07.3324 | ||||
| 23. Palla A, Donnamaria V, Petruzzelli S, et al. Enlargement of the right descending pulmonary artery in pulmonary embolism. Am J Roentgenol 1983; 141:513-7. http://dx.doi.org/10.2214/ajr.141.3.513 | ||||
| 24. Elliott CG, Goldhaber SZ, Visani L, DeRosa M. Chest radiographs in acute pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry. Chest 2000; 118:33-8. http://dx.doi.org/10.1378/chest.118.1.33 | ||||