Peripheral Pulmonary Lesions in Confirmed Pulmonary Arterial Embolism

Abstract

Purpose This retrospective study aimed to describe the B‐mode lung ultrasound (B‐LUS) and contrast‐enhanced ultrasound (CEUS) follow‐up patterns of peripheral pulmonary lesions (PPLs) in patients with confirmed pulmonary embolism (PE). Patients and Methods Data from 27 patients with a confirmed diagnosis of PE and PPLs over 5 mm from October 2009 to November 2018 were included retrospectively in the study. The inclusion criteria were performance of a baseline CEUS examination, a short‐term B‐LUS and CEUS follow‐up, and a long‐term B‐LUS follow‐up of PPLs. The homogeneity of enhancement of PPLs (homogeneous/inhomogeneous/absent) on CEUS and the presence and size of PPLs on B‐LUS were evaluated. Results A total of n = 25/27 (92.6%) lesions showed absent or inhomogeneous enhancement during baseline examination or short‐term follow‐up, indicating impaired perfusion. On short‐term CEUS follow‐up, 9/27 cases (33.3%) showed a pattern shift. On B‐LUS long‐term follow‐up, 26/27 lesions (96.3%) were detectable for an average of 10 weeks (range 3–32 weeks). The size of reference lesions was significantly reduced at the time of the final follow‐up examination (P < .05). Conclusion B‐LUS follow‐up showed that, in patients with confirmed PE, PPLs had a delayed regression. On CEUS follow‐up examination, various perfusion patterns of PPLs were observed, indicating the different ages and the variable reparative processes of pulmonary infarction. In PPLs independent of the underlying signs and symptoms, follow‐up B‐LUS and CEUS examinations may be helpful for a possible retrospective diagnosis of peripheral pulmonary infarction suggestive of PE.

New International Guidelines and Consensus on the Use of Lung Ultrasound

“…Significant experiences have been also reported on the use of CEUS imaging in case of post embolic subpleural consolidations of the lung. 162 , 163 , 164 …”

The Diagnostic Role of Lung Ultrasound and Contrast-Enhanced Ultrasound in Pulmonary Embolism

“…A recent study evaluated 27 patients with a diagnosis of PE confirmed by CTPA, and peripheral lung lesions by CEUS, both at the time of diagnosis and at follow-up. 50 The CEUS findings were classified into three patterns 50 :…”

B‐mode ultrasound and contrast‐enhanced ultrasound for evaluation of pneumonia: A pictorial essay

“…Furthermore, the lesions may reveal areas of absent perfusion during the pulmonary‐arterial phase with present (Figures 13 and 14) or absent perfusion (Figure 15) during the bronchial‐arterial phase. These patterns may be hypoxemia‐related due to the Euler–Liljestand mechanism 38 . In patients with pneumonia, local hypoxia may cause reflex vasoconstriction of pulmonary‐arterial vessels, with an increase of local flow resistance 39 .…”