Letter to the Editor
False Pulmonary Embolism on Computed Tomography Angiography in Two Patients With Thoracic Anatomic Distortion
Falso tromboembolismo pulmonar en la angiografía por tomografía computarizada en dos pacientes con distorsión anatómica del tórax
Luis Gorospe Sarasúa
, Ana María Ayala Carbonero, María Ángeles Fernández-Méndez
Corresponding author
Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain
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"Immune-mediated Leukopenia due to <span class="elsevierStyleItalic">Chlamydophila pneumoniae</span> Pneumonia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "663" "paginaFinal" => "664" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Leucopenia inmunomediada secundaria a neumonía por <span class="elsevierStyleItalic">Chlamydophila pneumoniae</span>" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 550 "Ancho" => 995 "Tamanyo" => 87530 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography showing right lower lobe 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"cor0005" ] ] ] 1 => array:2 [ "nombre" => "Ana María" "apellidos" => "Ayala Carbonero" ] 2 => array:2 [ "nombre" => "María Ángeles" "apellidos" => "Fernández-Méndez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Falso tromboembolismo pulmonar en la angiografía por tomografía computarizada en dos pacientes con distorsión anatómica del tórax" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2501 "Ancho" => 2724 "Tamanyo" => 421452 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Posteroanterior chest X-ray of a 52-year-old patient (henceforth patient X) with a history of lung cancer treated with chemotherapy and radiation therapy 7 years previously, showing complete atelectasis of the left upper lobe. (B) Posteroanterior X-ray of an 85-year-old patient (henceforth patient Y), showing extensive left pleural thickening and calcification and significant loss of volume in the ipsilateral hemithorax. (C) Axial CT of patient X apparently showing a filling defect in the left main pulmonary artery (arrow), mistakenly interpreted as PTE. (D) Axial CT of patient Y apparently showing another filling defect in the left main pulmonary artery (arrows) that was also mistakenly interpreted as PTE.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Computed tomography pulmonary angiography (CTPA) has become the gold standard imaging technique in the evaluation of patients with suspected pulmonary thromboembolism (PTE).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> PTE – acute or chronic – is confirmed on CTPA by filling defects in the pulmonary arteries. Several factors, whether technical or disease- or patient-related, can result in a suboptimal, low-quality CTPA, which can be misinterpreted by the radiologist.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report 2 cases of mistaken diagnosis of acute PTE in the emergency department of our hospital. Both patients complained of chest pain and dyspnea: both had elevated D-dimer levels and significant structural changes in the left hemithorax. In one of the patients, changes were due to post-radiation sequelae from lung cancer in clinical remission (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), and in the other they were caused by long-term pleural thickening from calcified tuberculosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Anatomical distortion of the chest structures in general (loss of left hemithorax volume, mediastinal shift), and of the pulmonary arteries in particular (traction and kinking) caused artefacts related with turbulent flow of both blood and intravenous contrast medium in the pulmonary arteries of the left hemithorax, visualized on CTPA as apparent pulmonary artery defects (<a class="elsevierStyleCrossRef" href="#fig0005">Figs. 1</a>C and D). Filling defects were ruled out by late phase acquisitions on chest CT (obtained when the intravenous contrast medium is more diluted), thus confirming that the observations were due to artefacts. Neither patients had other pulmonary circulation filling defects or signs of right cardiac cavity overload or deep vein thrombosis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Factors which may contribute to misreading a CTPA examination may be patient-related (such as artefacts caused by breathing or heart movements), technical (such as X-ray beam hardening or partial volume), or disease-related.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Disease-related artefacts have been reported to include impacted mucus in the bronchi, perivascular edema, or pulmonary artery sarcoma. However, as far as we are aware, this is the first description of structural changes (such as presented by our 2 patient) causing anatomical distortion of the pulmonary arteries, that in turn produced intravascular turbulence of blood and intravenous contrast flow.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We believe that these 2 cases underline the importance of understanding the physiopathology and intravascular hemodynamic consequences of structural changes in the chest that cause an anatomical distortion of the pulmonary arteries, in order to avoid misinterpretation during CTPA procedures.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gorospe Sarasúa L, Ayala Carbonero AM, Fernández-Méndez MÁ. Falso tromboembolismo pulmonar en la angiografía por tomografía computarizada en dos pacientes con distorsión anatómica del tórax. Arch Bronconeumol. 2015;51:662–663.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2501 "Ancho" => 2724 "Tamanyo" => 421452 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Posteroanterior chest X-ray of a 52-year-old patient (henceforth patient X) with a history of lung cancer treated with chemotherapy and radiation therapy 7 years previously, showing complete atelectasis of the left upper lobe. (B) Posteroanterior X-ray of an 85-year-old patient (henceforth patient Y), showing extensive left pleural thickening and calcification and significant loss of volume in the ipsilateral hemithorax. (C) Axial CT of patient X apparently showing a filling defect in the left main pulmonary artery (arrow), mistakenly interpreted as PTE. (D) Axial CT of patient Y apparently showing another filling defect in the left main pulmonary artery (arrows) that was also mistakenly interpreted as PTE.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging tests in the diagnosis of pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I.C. Mos" 1 => "F.A. Klok" 2 => "L.J. Kroft" 3 => "A. de Roos" 4 => "M.V. 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Humes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00246-007-9055-5" "Revista" => array:6 [ "tituloSerie" => "Pediatr Cardiol" "fecha" => "2008" "volumen" => "29" "paginaInicial" => "241" "paginaFinal" => "242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17849074" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Baffle thrombosis in an adult with remote prior scimitar vein repair mimicking massive pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.M. Shulman" 1 => "J. Ayres" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clinimag.2014.03.007" "Revista" => array:6 [ "tituloSerie" => "Clin Imaging" "fecha" => "2014" "volumen" => "38" "paginaInicial" => "518" "paginaFinal" => "521" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24731564" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000012/v1_201512080104/S1579212915003183/v1_201512080104/en/main.assets" "Apartado" => array:4 [ "identificador" => "45358" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000012/v1_201512080104/S1579212915003183/v1_201512080104/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003183?idApp=UINPBA00003Z" ]
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| 2020 October | 57 | 12 | 69 |
| 2020 September | 57 | 17 | 74 |
| 2020 August | 49 | 18 | 67 |
| 2020 July | 57 | 20 | 77 |
| 2020 June | 53 | 16 | 69 |
| 2020 May | 62 | 14 | 76 |
| 2020 April | 54 | 23 | 77 |
| 2020 March | 64 | 19 | 83 |
| 2020 February | 56 | 27 | 83 |
| 2020 January | 73 | 18 | 91 |
| 2019 December | 84 | 17 | 101 |
| 2019 November | 57 | 30 | 87 |
| 2019 October | 55 | 9 | 64 |
| 2019 September | 75 | 22 | 97 |
| 2019 August | 45 | 21 | 66 |
| 2019 July | 48 | 26 | 74 |
| 2019 June | 36 | 15 | 51 |
| 2019 May | 36 | 18 | 54 |
| 2019 April | 46 | 47 | 93 |
| 2019 March | 53 | 41 | 94 |
| 2019 February | 38 | 31 | 69 |
| 2019 January | 37 | 17 | 54 |
| 2018 December | 36 | 22 | 58 |
| 2018 November | 44 | 25 | 69 |
| 2018 October | 69 | 31 | 100 |
| 2018 September | 34 | 14 | 48 |
| 2018 May | 21 | 0 | 21 |
| 2018 April | 19 | 4 | 23 |
| 2018 March | 12 | 3 | 15 |
| 2018 February | 14 | 7 | 21 |
| 2018 January | 23 | 6 | 29 |
| 2017 December | 30 | 6 | 36 |
| 2017 November | 16 | 5 | 21 |
| 2017 October | 21 | 7 | 28 |
| 2017 September | 20 | 8 | 28 |
| 2017 August | 21 | 10 | 31 |
| 2017 July | 15 | 8 | 23 |
| 2017 June | 27 | 9 | 36 |
| 2017 May | 21 | 3 | 24 |
| 2017 April | 16 | 4 | 20 |
| 2017 March | 12 | 6 | 18 |
| 2017 February | 11 | 2 | 13 |
| 2017 January | 12 | 5 | 17 |
| 2016 December | 15 | 10 | 25 |
| 2016 November | 20 | 15 | 35 |
| 2016 October | 21 | 21 | 42 |
| 2016 September | 20 | 9 | 29 |
| 2016 August | 19 | 4 | 23 |
| 2016 July | 20 | 7 | 27 |
Show all
