Spontaneously hyperattenuating thrombi revealing acute central pulmonary embolism on unenhanced CT.
(2019) Diagnostic and interventional imaging — Vol. 100, n° 11, p. 729-730 (2019)
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- A 49-year-old man with a history of congenital cardiopathy underwent unenhanced chest computed tomography (CT) for dyspnea and severe oxygen desaturation (blood O2 level = 70%) in a setting of acute renal failure (serum creatinine level = 1.85 mg/dL). CT revealed spontaneously hyperattenuating areas (70 HU) within proximal pulmonary arteries (Fig. 1a and b). There were neither pleural effusions nor lung parenchyma abnormalities. Acute central pulmonary embolism was suggested and the patient was admitted to the intensive care unit with respiratory support and low molecular weight heparin anticoagulation. Five days later, improvement of renal function allowed completion of contrast-enhanced chest CT, which confirmed the presence of thrombi (Fig. 1c) in the same locations than those of hyperattenuating areas seen on unenhanced CT. Thrombi were slightly smaller, which can be explained by physiological thrombolysis. This observation reminds us that acute central pulmonary embolism may sometimes be detected –mainly depending of hematocrit level and the age and composition of the clot [1], [2]– on unenhanced chest CT with narrow windowing, which allows initiation of the appropriate therapy. [...]
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Dermesropian, F., & Ghaye, B. (2019). Spontaneously hyperattenuating thrombi revealing acute central pulmonary embolism on unenhanced CT. Diagnostic and interventional imaging, 100(11), 729-730. https://doi.org/10.1016/j.diii.2019.03.004 (Original work published 2019)