Pitfalls in the Diagnosis of Acute Pulmonary Embolism on Computed Tomography: Common Pathologic and Imaging Mimics
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Purpose of Review
Acute pulmonary embolism (PE) is the third most-common acute cardiovascular disease in the United States. Nearly 900,000 new diagnoses are made each year, with 250,000 associated hospitalizations and up to 100,000 deaths (Palacio et al. in Semin Roentgenol 50(3):217–225, 2015; Metter et al. in Am J Roentgenol 208(3):489–494, 2017; Jaff et al. in Circulation 123(16):1788–830, 2011). Timely and accurate diagnosis of acute PE is crucial for the prevention of most deaths associated with PE, even more so than optimal medical therapy (Palacio et al. in Semin Roentgenol 50(3):217–225, 2015; Jaff et al. in Circulation 123(16):1788–830, 2011; Raja et al. in Ann Intern Med 163(9):701, 2015).
Computed tomography (CT) has emerged as the primary imaging modality used in the diagnosis of acute PE. Thus, radiologists play a key role in the correct diagnosis of acute PE, and must differentiate this diagnosis from other conditions that mimic the imaging findings of acute PE, as well as from artifacts associated with imaging techniques (Palacio et al. in Semin Roentgenol 50(3):217–225, 2015; Jaff et al. in Circulation 123(16):1788–830, 2011; Raja et al. in Ann Intern Med 163(9):701, 2015). Understanding how these diagnoses present on CT is necessary for improved patient care.
This article will discuss the diagnosis of acute PE with CT, the diagnosis of diseases that may be mistaken for acute PE, and how to identify imaging artifacts that may be mistaken for an acute PE.
KeywordsAcute pulmonary embolism Chest imaging Acute cardiovascular disease
Compliance with Ethical Guidelines
Conflict of interest
Caroline L. Robb, Sanjeev Bhalla, and Constantine A. Raptis: each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 1.•Palacio D, Benveniste MF, Betancourt-Cuellar SL, Gladish GW. Multidetector computed tomography pulmonary angiography pitfalls in the evaluation of pulmonary embolism with emphasis in technique. Semin Roentgenol. 2015;50(3):217–225. https://doi.org/10.1053/j.ro.2015.01.012. Palacio et al. provide a thorough review of common imaging pitfalls in the diagnosis of acute PE, including diagnostic errors related to image acquisition and imaging artifacts.
- 3.Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123(16):1788–830. https://doi.org/10.1161/CIR.0b013e318214914f.CrossRefPubMedGoogle Scholar
- 7.•Wijesuriya S, Chandratreya L, Medford AR. Chronic pulmonary emboli and radiologic mimics on CT pulmonary angiography: a diagnostic challenge. Chest. 2013;143(5):1460–1471. https://doi.org/10.1378/chest.12-1384. Wijesuriya et al. provide a comprehensive, updated review of the accurate diagnosis of CPTD on CT and how to differentiate CPTD from acute PE.
- 9.••Devaraj A, Sayer C, Sheard S, Grubnic S, Nair A, Vlahos I. Diagnosing acute pulmonary embolism with computed tomography: imaging update. J Thorac Imaging. 2015;30(3):176–192. https://doi.org/10.1097/rti.0000000000000146. Devaraj et al. provide an updated review of recent literature regarding the utilization of CTPA in the diagnosis of acute PE, including how to optimize CTPA image acquisition and avoid common imaging pitfalls in the diagnosis of acute PE.
- 10.•Unal E, Balci S, Atceken Z, Akpinar E, Ariyurek OM. Nonthrombotic Pulmonary artery embolism: imaging findings and review of the literature. AJR Am J Roentgenol. 2017;208(3):505–516. https://doi.org/10.2214/ajr.16.17326. In this article, Unal et al. discuss common pathologic, nonthrombotic mimics of acute PE and how to differentiate these mimics from acute PE.