The filling defect of pulmonary artery, an imaging finding what we should know

Liu, Min; Tao, Xincao; Zhai, Zhenguo; Ma, Zhanhong; Zhu, Ling; Luo, Jie

doi:10.1177/2045894020910687

Cited by 10 publications

(5 citation statements)

References 37 publications

(48 reference statements)

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“…However, it is unlikely that our patient had DVT because there were no supporting clinical findings such as warmth or pain in the extremity or asymmetrical swelling [15]. PE could also be ruled out because there was also no filling defect in the pulmonary artery in the chest CT scan evaluation [16].…”

Section: Discussionmentioning

confidence: 89%

To reperfuse or not to reperfuse: a case report of Wellens’ syndrome with suspected COVID-19 infection

et al. 2020

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Background Wellens’ syndrome is known to be associated with left anterior descending artery occlusion that could lead to an extensive anterior wall myocardial infarction. Thus, emergency cardiac catheterization is needed. However, during coronavirus disease 2019 (COVID-19) pandemic, it is recommended for hemodynamically stable acute coronary syndrome patients with COVID-19 infection to be treated conservatively in an isolated hospital ward. Case presentation We report an 85-year-old patient with chief complaints of typical, squeezing chest pain in the past 4 h. The patient had a high fever, dyspnea, sore throat, and fatigue for 3 days. He had previously come into contact with COVID-19 positive relatives. The patient was hemodynamically stable and pulmonary auscultation revealed coarse rales in the entire lung. Electrocardiography (ECG) evaluation during the pain episode showed non-specific ST-T changes in lead V2-V5. After sublingual nitrate was administered, ECG evaluation during the pain-free period revealed a biphasic T wave inversion in lead V2 and V3. Laboratory workup showed elevated cardiac marker and leucopenia with neutrophilia and lymphopenia. Rapid immunochromatographic test and initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) evaluation from nasopharyngeal swab showed negative results. However, radiographic evaluations suggest the diagnosis of COVID-19 infection. While waiting for the second RT-PCR evaluation, the patient was diagnosed with Wellens’ syndrome with suspected COVID-19 infection. The patient was treated conservatively according to national guidelines and scheduled for elective cardiac catheterization. On the third day, the patient felt better and insisted on being discharged home. Ten days after discharged, the patient died of myocardial infarction. Conclusion Emergency cardiac catheterization should be done for patient with Wellens’ syndrome, regardless of the COVID-19 infection status.

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Section: Discussionmentioning

confidence: 89%

To reperfuse or not to reperfuse: a case report of Wellens’ syndrome with suspected COVID-19 infection

et al. 2020

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“…New PE, recurrent or unresolving PE refractory to anticoagulation, and PE mimics, such as pulmonary artery tumours, pulmonary IgG4-related disease, Takayasu arteritis, Behçet’s disease, and Hughes-Stovin syndrome 12…”

Section: Answersmentioning

confidence: 99%

A man in his 30s with recurrent cough, fever, dyspnoea, and chest pain

Zhao

Huang

et al. 2022

BMJ

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“…Using follow-up CT, Venmans et al (23) reported the incidence of PCE after PVP to be 26% (95% CI: 16-39%). In osteoporotic vertebral compression fractures, PCE was detected with CT in 23% of PVP sessions, developed in the distal to third-order pulmonary arteries, and was related to leakage into the inferior vena cava (16,24). In a systematic review, the incidence of PCE ranged widely, from 1.9% to 26% (11).…”

Section: Discussionmentioning

confidence: 99%

CT features and risk factors of pulmonary cement embolism after vertebroplasty or kyphoplasty in patients with vertebral compression fracture: a retrospective cohort study

Sun¹,

Deng²,

Xu³

et al. 2023

Quant Imaging Med Surg

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Background: Pulmonary cement embolism (PCE) caused by cement leakage is one of the complications of percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). The aim of our study was to explore the imaging features on computed tomography (CT) and analyze the risk factors of PCE in patients with a vertebral compression fracture to compare the incidences of PCE caused by PVP and PKP.Methods: In this single-center, retrospective study, 373 patients (96 males and 277 females; mean age 76.2±9.4 years) from January 2017 to December 2020 who underwent PVP or PKP for treatment of vertebral compression fracture in the China-Japan Friendship Hospital were retrospectively included. Their clinical data were recorded, and their postprocedural chest CT scans were reviewed and evaluated for PCE.Results: Of the 373 patients, 258 patients underwent PVP while the other 115 underwent PKP. PCE was found on the postprocedural chest CT scans in 64 patients (17.2%), including 47 patients with PVP and 17 patients with PKP. The incidence of PCE of PVP and PKP was similar (χ 2 =0.660; P=0.460). The typical CT findings of PCE were multiple linear or branching radiopaque densities in pulmonary arteries.The upper lobes of bilateral lungs were the most frequently involved. In addition, postprocedural chest CT demonstrated that 103 cases had cement emboli in the azygos vein, and 8 cases had cement emboli in the inferior vena cava. Binary logistic regression analysis demonstrated that PVP or PKP in the T9 vertebra [odds ratio (OR) =4.222; 95% CI: 1.490-11.966] and cement emboli in the azygos vein (OR =7.647; 95% CI: 3.937-14.856) or the inferior vena cava (OR =42.701; 95% CI: 7.525-242.302) were the risk factors of PCE. Conclusions:The incidence of PCE during PVP or PKP was 17.2%. Postprocedural chest CT clearly showed PCE as branching hyperdense or radiopaque lesions confined within the pulmonary artery courses.

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The filling defect of pulmonary artery, an imaging finding what we should know

Cited by 10 publications

References 37 publications

To reperfuse or not to reperfuse: a case report of Wellens’ syndrome with suspected COVID-19 infection

To reperfuse or not to reperfuse: a case report of Wellens’ syndrome with suspected COVID-19 infection

A man in his 30s with recurrent cough, fever, dyspnoea, and chest pain

CT features and risk factors of pulmonary cement embolism after vertebroplasty or kyphoplasty in patients with vertebral compression fracture: a retrospective cohort study

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