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Imaging Features of Nonthrombotic Pulmonary Arterial Embolism 非血栓性肺动脉栓塞的影像学特征 History: · 61-year-old man with complaints of fatigue, cough, fever and shortness of breath. · The patient had a history of poorly controlled type 2 diabetes mellitus for 10 years and patient also had an ulcerating wound on the plantar aspect of his right foot, which has been present for 2 months. Diagnosis: Septic embolism(脓毒性栓塞) Contrast-enhanced CT images with mediastinum (a) and lung window settings (b) shows bilateral, cavitary lung nodules with a predilection of peripheral distribution (arrows). There is also a loculated pleural fluid in the right hemithorax (arrowheads). History: · 57-year-old transexual male with complaints of progressive dyspnea. · The patient had a history of breast silicone implantation 9 years ago. Diagnosis: Silicon embolism(硅栓塞) a) Noncontrast axial image shows calcified breast implants and wall irregularities suggesting implant rupture. b,c) Axial CT images with lung window settings demonstrates extensive bilateral reticular opacities and interlobular septal thickening. History: 59-year-old woman presented with a sudden onset shortness of breath and chest pain. The patient was diagnosed with liver hydatid cyst in 2-months ago. Diagnosis: Hydatid cyst embolism(包虫囊肿栓塞) (a) Contrast-enhanced axial CT image shows occlusion and expansion of right upper lobe pulmonary artery by peripherally enhancing thick-walled complex cystic structure consistent with intravascular hydatid disease (arrows). There is also an increase in the diameter of the main pulmonary artery. (b) Axial CT image with lung window settings shows right upper lobe hyperlucency secondary to oligaemia. (c) Axial CT image at the liver level shows cystic lesions consistent with hydatid cyst are invading inferior vena cava (arrowheads). History: 64-year-old female with known metastatic cervix carcinoma. 18F-FDG PET/CT examination is available for staging. Diagnosis: F-18 fluorodeoxyglucose (FDG) embolism (F-18氟脱氧葡萄糖(FDG)栓塞)A) Fused PET-CT image shows focal FDG uptake with intense activity. B, C) Axial unenhanced CT images shows there is no corresponding CT abnormality.
History: 61-year-old woman with shortness of breath after thoracic spine decompression surgery. Diagnosis: Macroscopic fat embolism(脂肪栓塞) (a) Axial contrast enhanced pulmonary CT angiography image shows a fat density (-23.5 Hounsfield unit) filling defect in the left lower lobe pulmonary artery compatible with fat embolism. (b) Axial contrast enhanced pulmonary CT angiography image obtained from right atrium level shows fat density (between -33.1 and -88.1 Hounsfield units) filling defects in the right atrium. Right atrium volume was also significantly reduced (*).
History: 64-year-old man with shortness of breath and altered mental status developed suddenly 3 days after ipsilateral fractures of the left femur and tibia. Diagnosis: Microscopic fat embolism(脂肪栓塞) After exclusion of pulmonary thromboembolism, the patient was considered to have severe form of fat embolism. Axial CT image shows bilateral, widespread ground-glass opacities and bilateral pleural effusion. On the 5th day of the follow-up, he was died in the intensive care unit.
History: 62-year-old woman with a recent onset respiratory distress after lumbar vertebroplasty. Diagnosis: Cement embolism(骨水泥栓塞) (a) Posterior-anterior chest x-ray shows multiple small linear opacities in the both lungs (arrows) and a wide opacity in linear internal structure at left main pulmonary artery level (dashed arrow). Chest x-ray also shows a Westermark sign, with an oligemia in the left lung and cutoff of the left pulmonary artery. The opacity in the left lower zone was confirmed to be in the skin (arrowheads). (b, c) Contrast-enhanced axial CT image and coronal reconstructed CT image shows hyperdense cement material in the left main pulmonary artery (dashed arrows) and multiple small linear opacities in segmental pulmonary arteries (arrows).
History: 27-year-old woman with shortness of breath, hypotension and mental status changes developed shortly after giving birth and transthoracic echocardiography revealed right ventricle overload. Diagnosis: Amniotic fluid embolism(羊水栓塞) (a) Axial contrast-enhanced CT image with mediastinum window shows enlargement of main pulmonary artery diameter. There is no filling defect within the pulmonary arteries and pulmonary thromboembolism was excluded . (b) Axial CT image with lung window shows bilateral, peripherally disturbed patchy ground-glass opacities and thickening of both major fissures consistent with pulmonary edema.
History: 47-year-old man with known metastatic renal cell carcinoma. Chest CT examination is available for routine follow-up. Diagnosis: Pulmonary tumor thrombotic microangiopathy(肺肿瘤血栓性微血管病变) A) Axial chest CT image shows beaded appearance and enlargement of left upper lobe anterior segmental pulmonary artery and subsegmental branches (arrowheads). B) Magnified chest CT image shows beaded appearance of pulmonary artery. Note that the diameter of the beaded pulmonary artery is wider than the others.
History: 56-year-old man with metastatic lung squamous cell carcinoma. Diagnosis: Pulmonary tumor embolism(肺肿瘤栓塞) Axial contrast-enhanced chest CT image shows tumor invading left main pulmonary artery (*) and occluded left upper lobe pulmonary artery (arrowheads).
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