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Rofo 2020; 192(01): 38-49
DOI: 10.1055/a-0900-4200
Review
© Georg Thieme Verlag KG Stuttgart · New York

Acute Pulmonary Embolism: Imaging Techniques, Findings, Endovascular Treatment and Differential Diagnoses

Akute Lungenarterienembolie: Bildgebung, Bildbefunde, endovaskuläre Therapie und Differenzialdiagnosen
Viktoria Palm
1   Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
,
Fabian Rengier
2   Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
,
Prabhakar Rajiah
3   Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, United States
,
Claus Peter Heussel
4   Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
,
Sasan Partovi
5   Interventional Radiology Section, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
› Author Affiliations
Further Information

Publication History

05 December 2018

14 April 2019

Publication Date:
28 May 2019 (online)

Also available at
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Abstract

Background Acute thrombotic pulmonary embolism (PE) is a common and potentially fatal event with imaging playing a pivotal role in the diagnosis and management of these patients.

Method This review discusses imaging techniques, diagnostic algorithms, imaging findings and endovascular treatment of acute thrombotic PE, and illustrates important differential diagnoses relating to the spectrum of acute non-thrombotic PE and non-embolic pulmonary artery disease. The review emphasizes information relevant for everyday radiological practice and highlights recent advances that can be readily applied in the clinical routine.

Results/Conclusion Computed tomography pulmonary angiography (CTPA) is the current reference standard for the diagnosis of acute PE. Ventilation and perfusion (VQ) scanning or – in centers with adequate expertise – magnetic resonance imaging (MRI) is indicated in pregnant or young patients and patients with contraindications to iodinated contrast. Invasive angiography is reserved for patients with intended endovascular treatment. Artifacts, acute non-thrombotic PE, chronic PE and non-embolic pulmonary artery diseases should always be considered as differential diagnoses.

Key points: 

  • CTPA is the reference standard for the diagnosis of acute PE.

  • MRI for acute PE should only be performed in centers with adequate expertise.

  • Invasive angiography is reserved for patients with intended endovascular treatment.

  • Artifacts and non-embolic pulmonary artery diseases can mimic acute pulmonary thromboembolism.

  • Non-thrombotic and chronic PE are also differential diagnoses of acute pulmonary thromboembolism.

Citation Format

  • Palm V, Rengier F, Rajiah P et al. Acute Pulmonary Embolism: Imaging Techniques, Findings, Endovascular Treatment and Differential Diagnoses. Fortschr Röntgenstr 2020; 192: 38 – 49

Zusammenfassung

Hintergrund Die akute thrombotische Lungenarterienembolie (LAE) ist ein häufiges und potenziell tödliches Ereignis. Die Bildgebung spielt bei diesen Patienten für Diagnose und Management eine herausragende Rolle.

Methode Dieser Übersichtsartikel diskutiert Bildgebung, diagnostische Vorgehensweisen, Bildbefunde und endovaskuläre Behandlungsmöglichkeiten der akuten thrombotischen LAE und illustriert wichtige Differenzialdiagnosen bezüglich des Spektrums akuter nicht thrombotischer LAE und nicht embolischer Lungenarterienpathologien. Der Artikel hebt Informationen mit Relevanz für den radiologischen Alltag besonders hervor und geht auch auf aktuelle Fortschritte ein, die heute in der klinischen Routine angewandt werden können.

Ergebnisse/Schlussfolgerung Die computertomografische pulmonale Angiografie (CTPA) ist der aktuelle Referenzstandard für die Diagnose der akuten LAE. Die Ventilations-Perfusions- (VQ-) Bildgebung oder – in Zentren mit adäquater Expertise – die Magnetresonanztomografie (MRT) sind bei schwangeren oder jungen Patienten sowie Patienten mit Kontraindikationen für jodhaltige Kontrastmittel indiziert. Die invasive Angiografie bleibt Patienten mit der Intention einer endovaskulären Behandlung vorbehalten. Artefakte, akute nicht thrombotische LAE, chronische LAE und nicht embolische Lungenarterienpathologien sollten immer als Differenzialdiagnosen in Betracht gezogen werden.

Kernaussagen: 

  • CTPA ist Referenzstandard für die Diagnose der akuten LAE.

  • MRT der akuten LAE sollte nur in Zentren mit adäquater Expertise durchgeführt werden.

  • Invasive Angiografie bleibt Patienten mit endovaskulärer Behandlung vorbehalten.

  • Artefakte und nicht embolische Lungenarterienpathologien können die akute LAE imitieren.

  • Nicht thrombotische und chronische LAE sind weitere Differenzialdiagnosen der akuten thromboembolischen LAE.

Key words

pulmonary artery - computed tomography angiography - magnetic resonance imaging - digital subtraction angiography - endovascular procedures - pulmonary embolism
 

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