Pulmonary vein thrombosis in patients with medical risk factors.

Pulmonary vein thrombosis in patients with medical illnesses has been rarely reported, and it is also rarely reported in those with no risk factors. We report 2 patients with pulmonary vein thrombosis, 1 with metastatic renal cell carcinoma and 1 with presumed pulmonary aspergillosis. Thrombi or tumors in a pulmonary vein are clinically important because they may cause systemic embolism or hemoptysis.

Ancillary findings on CT pulmonary angiograms and abnormalities on chest radiographs in patients in whom pulmonary embolism was excluded.

To determine whether chest radiographs identify some abnormalities not shown as ancillary findings on computed tomography(CT) pulmonary angiograms of patients in whom pulmonary embolism (PE) was excluded. This was a retrospective study of reports of negative 64-detector CT pulmonary angiograms and chest radiographs. Among 332 patients with no PE, pulmonary parenchymal disease was shown in 60 (18%) only on standard chest radiographs, and pleural or pericardial disease was shown in 17 (5%) only on chest radiographs. Skeletal abnormalities were reported more frequently on standard chest radiographs, lymph nodes more frequently on CT angiograms. Some abnormalities on chest radiographs of patients in whom PE is excluded may not be described as ancillary findings on CT pulmonary angiograms. This suggests a need for ancillary findings on CT pulmonary angiograms to be described systematically. At present, however, plain chest radiographs in some patients show ancillary findings not reported on CT angiograms. [corrected].

Resolution of pulmonary embolism on CT pulmonary angiography.

OBJECTIVE: The objective of our study was to retrospectively determine the rate of resolution of pulmonary emboli (PEs) in individual vessels and the rate of complete resolution of PEs on CT angiography. MATERIALS AND METHODS: Follow-up CT pulmonary angiograms, obtained during the period from January 2006 through May 2009, of 69 patients with acute PE from two hospitals were assessed. Initial and follow-up CT angiograms were reread together by one radiologist at both of the hospitals. Images were obtained using a 10-, 16-, 40-, or 64-MDCT angiography unit with a 0.5-mm collimation, 1.25- to 2.0-mm reconstruction, 0.3- to 0.5-second rotation time, and 7.5-mm/rotation table speed. All CT angiograms were obtained using a PE protocol. RESULTS: Follow-up CT angiograms were obtained in 35 men and 34 women who ranged in age from 17 to 92 years (mean age, 58 +/- 17 [SD] years). Complete CT angiographic resolution of PE was seen in six of 15 patients (40%) 2-7 days after diagnostic imaging. After day 28, complete resolution occurred in 17 of 21 patients (81%). The main pulmonary arteries showed complete PE resolution during days 2-7 in seven of nine patients (78%) and after day 28 in 34 of 36 (94%). The lobar pulmonary arteries showed complete resolution of PE during days 2-7 in 23 of 33 patients (70%) and after 28 days in 44 of 48 (92%). The segmental pulmonary arteries showed complete resolution during days 2-7 in eight of 21 patients (38%) and after day 28 in 38 of 38 (100%). CONCLUSION: Most patients (81%) showed complete resolution of PE on CT angiography after 28 days. PEs resolved faster in the main and lobar pulmonary arteries than in the segmental branches.

CT venous phase venography with 64-detector CT angiography in the diagnosis of acute pulmonary embolism.

The value of computed tomographic (CT) venography in combination with CT pulmonary angiography has been questioned because of the potential dangers of radiation. Accordingly, we retrospectively evaluated the diagnostic yield of 64-detector CT angiography with CT venography. Among patients who routinely underwent CT venography with CT angiography, the CT angiogram showed acute pulmonary embolism (PE) in 206 of 1903 patients (10.8%). A positive CT venogram in a patient with a negative CT angiogram was shown in 25 of 1903 patients (1.3%). Either the CT angiogram or the CT venogram showed venous thromboembolism in 231 of 1903 patients (12.1%). The proportion of patients with venous thromboembolism diagnosed only by a CT venogram was 25 of 231 (10.8%). In conclusion, the proportion of patients with venous thromboembolism diagnosed only by a CT venogram is sufficiently high to merit consideration of its use especially in those at high risk for DVT.

Ankle exercise and venous blood velocity.

Ankle exercise increases venous blood velocity while supine, but the effect of ankle exercise on venous blood velocity while sitting is not known. In this investigation, we test the hypothesis that venous blood velocity can be increased while sitting by repetitive dorsiflexion of the foot. Time-averaged peak velocity (TAPV) in the popliteal vein of 20 healthy male volunteers was measured by pulsed Doppler ultrasound at rest and during ankle exercise in the supine and sitting positions. Right popliteal vein TAPV while supine at rest was 11 cm/second (sec) (95% confidence interval [CI] =9-13 cm/sec) and with ankle exercise it increased to 24 cm/sec (95% CI =20-28 cm/sec) (p<0.0001). With sitting at rest, right popliteal vein blood TAPV decreased from 11 cm/sec to 3 cm/sec (95% CI = 2-4 cm/sec) (p<0.0001). With ankle exercise while sitting, right popliteal vein TAPV increased to 18 cm/sec (95% CI =15-21 cm/sec) (p<0.0001). In conclusion, in both the supine and sitting positions, ankle exercise increased venous blood velocity, thereby transiently reducing a tendency toward venous stasis. Such ankle exercise might be useful in the prevention of stasis-induced deep venous thrombosis.