Korean J Radiol.  2016 Apr;17(2):198-208. 10.3348/kjr.2016.17.2.198.

Advances in Multidetector CT Diagnosis of Pediatric Pulmonary Thromboembolism

• Thacker PG
• Lee EY

• KMID: 2360204
• DOI: http://doi.org/10.3348/kjr.2016.17.2.198

Abstract

Although pediatric pulmonary thromboembolism is historically believed to be rare with relatively little information available in the medical literature regarding its imaging evaluation, it is more common than previously thought. Thus, it is imperative for radiologists to be aware of the most recent advances in its imaging information, particularly multidetector computed tomography (MDCT), the imaging modality of choice in the pediatric population. The overarching goal of this article is to review the most recent updates on MDCT diagnosis of pediatric pulmonary thromboembolism.

Keyword

Pulmonary embolism; Dual-energy; Computed tomography

MeSH Terms

Humans
Image Processing, Computer-Assisted
Multidetector Computed Tomography/instrumentation/*methods
Pediatrics
Pulmonary Embolism/physiopathology/*radiography
Risk Factors

Figure

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  Fig. 1 Receiver operative characteristic curve for differentiating patients with pulmonary thromboembolism from those without pulmonary thromboembolism based on total number of risk factors (immobilization, indwelling central venous line, prior pulmonary thromboembolism and/or deep venous thrombosis, hypercoagulable state, and excess estrogen state). Dashed line = 45° line of nondiscrimination (equivalent to coin tossing). Area under curve of 0.934 indicates excellent discrimination (p = 0.0001). Reproduced from Lee et al. Radiology 2012;262:242-251, with permission of Radiology Society of North America (18). CI = confidence interval

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  Fig. 2 16-year-old boy with history of double outlet right ventricle status post Fontan procedure who presented with shortness of breath. A. Initial axial enhanced computed tomographic image showing low attenuation area (arrow) within Fontan pathway concerning for possible thrombosis. B. Subsequently obtained delayed axial computed tomographic image demonstrating homogeneous opacification of Fontan pathway (arrow) similar to other cardiovascular structures, confirming absence of thrombosis.

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  Fig. 3 Acute pulmonary embolism on dual-energy computed tomography. A. Sagittal reformatted image demonstrating occlusive pulmonary embolism (arrow) in posterior basal branch of right pulmonary artery. B. Dual-energy computed tomography blood pool map demonstrating corresponding wedge-shaped area of decreased perfusion (arrows) in posterior basal right lower lobe. C. Coronal reformatted image from contrast-enhanced dual-energy computed tomography demonstrating occlusive thrombus (arrows) in left lower lobe pulmonary artery. D. Corresponding tissue-specific thrombus analysis demonstrating thrombus as red filling defect (arrows) with blue-shaped pulmonary artery. Images provided by courtesy of Dr. Long Jiang Zhang, Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, China.

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  Fig. 4 15-year-old girl with oral contraceptive medication who presented with acute shortness of breath and chest pain. A. Axial enhanced computed tomographic image showing low attenuation area (arrow) near right lower lobe pulmonary arteries. It was initially interpreted as lymph nodes based on axial computed tomographic image alone. Also noted are bilateral pleural effusions. B. Coronal enhanced computed tomographic image demonstrating intraluminal filling defect (arrow) in right lower lobe pulmonary artery, confirming diagnosis of pulmonary embolism which was initially overlooked based on axial computed tomographic image alone (A).

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  Fig. 5 4-year-old girl with neuroblastoma who presented with shortness of breath and chest pain. Axial enhanced computed tomographic image showing bilateral pulmonary embolism (arrows).

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  Fig. 6 17-year-old African-American male with recent history of immobilization after motor vehicle collision and acute onset of tachycardia. Axial contrast-enhanced chest computed tomographic image through lower lobe demonstrating small bilateral pleural effusions and peripheral opacities, some of which are wedge-shaped (arrows), consistent with parenchymal changes of pulmonary emboli (not shown on this). Additionally, there is subtle mosaic attenuation of lungs with lower lobes more opacified in respect to partially visualized right middle lobe and lingula, subtle indirect finding of pulmonary emboli due to nonuniform perfusion.

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  Fig. 7 15-year-old girl with repaired congenital heart disease who presented with acute right sided chest pain. A. Axial enhanced computed tomographic image showing filling defect (arrow) in right lower lobe segmental pulmonary artery. Also noted is right pleural effusion. B. Axial lung window computed tomographic showing wedge shaped (arrows) opacity consistent with lung infarction from pulmonary embolism.

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  Fig. 8 16-year-old girl with oral contraceptive medication and chronic pulmonary embolism. Coronal maximum intensity projection computed tomographic image showing eccentric filling defects (arrows) which form obtuse margin with vessel wall. Also noted are several prominent enlarged bronchial arteries (arrowheads) coursing along pulmonary arteries containing chronic pulmonary embolism.

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