March 7, 2009

Chronic Pulmonary Embolism

Fig. 1&2: Axial CT image shows a partial thrombus (stars) in the main and proximal left pulmonary artery that forms an obtuse angle with the vessel wall. There is enlarged pulmonary artery and bronchial collaterals (arrows).


  • Some pulmonary emboli do not resolve and form endothelialized fibrosis of pulmonary vascular bed, thought to be due to disturbance in thrombus resolution
  • Results: pulmonary HT, cor pulmonale, bronchial hypertrophy
  • Multiple episodes of PE
  • Younger age
  • Larger perfusion defect
  • Idiopathic cause of PE
CT signs
  • Complete thrombus with small vascular diameter
  • Partial crescent-shaped, eccentric thrombus
  • Calcified thrombus
  • Web, band
  • Pulmonary hypertension
  • Collaterals from bronchial arteries
  • Mosaic attenuation of the lungs
Castaner E, et al. CT diagnosis of chronic pulmonary thromboembolism. Radiographics 2009;29:31-50.

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