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nt events random article about wikipedia contact us contribute help learn to edit community portal recent changes upload file special pages search search appearance donate create account log in personal tools donate create account log in contents move to sidebar hide top 1 diagnostic use 2 contraindications 3 acquisition 4 interpretation 5 references toggle the table of contents ct pulmonary angiogram 3 languages العربية русский oʻzbekcha ўзбекча edit links article talk english read edit view history tools tools move to sidebar hide actions read edit view history general what links here related changes upload file permanent link page information cite this page get shortened url switch to legacy parser print export download as pdf printable version in other projects wikidata item appearance move to sidebar hide from wikipedia the free encyclopedia medical imaging of blood flow between heart and lungs medical intervention ct pulmonary angiogram example of a ctpa demonstrating a saddle embolus the white area above the center is the pulmonary artery opacified by radiocontrast inside it the grey matter is blood clot the black areas on either side are the lungs with around it the chest wall ops 301 code 3 222 a ct pulmonary angiogram ctpa is a medical diagnostic test that employs computed tomography ct angiography to obtain an image of the pulmonary arteries its main use is to diagnose pulmonary embolism pe 1 it is a preferred choice of imaging in the diagnosis of pe due to its minimally invasive nature for the patient whose only requirement for the scan is an intravenous line modern mdct multi detector ct scanners are able to deliver images of sufficient resolution within a short time period such that ctpa has now supplanted previous methods of testing such as direct pulmonary angiography as the gold standard for diagnosis of pulmonary embolism 2 the patient receives an intravenous injection of an iodine containing contrast agent at a high rate using an injector pump images are acquired with the maximum intensity of radio opaque contrast in the pulmonary arteries this can be done using bolus tracking a normal ctpa scan will show the contrast filling the pulmonary vessels appearing as bright white any mass filling defects such as an embolus will appear dark in place of the contrast filling blocking the space where blood should be flowing into the lungs diagnostic use edit pulmonary emboli can be classified according to level along the pulmonary arterial tree ct pulmonary angiogram showing segmental and subsegmental pulmonary emboli on both sides further information pulmonary embolism ctpa was introduced in the 1990s as an alternative to ventilation perfusion scanning v q scan which relies on radionuclide imaging of the blood vessels of the lung it is regarded as a highly sensitive and specific test for pulmonary embolism 1 ctpa is typically only requested if pulmonary embolism is suspected clinically if the probability of pe is considered low a blood test called d dimer may be requested if this is negative and risk of a pe is considered negligible then ctpa or other scans are generally not performed most patients will have undergone a chest x ray before ctpa is requested 1 after initial concern that ctpa would miss smaller emboli a 2007 study comparing ctpa directly with v q scanning found that ctpa identified more emboli without increasing the risk of long term complications compared to v q scanning 3 a v q scan may still be recommended when a lower radiation dose is required 4 on ctpa acute emboli have been found at radiodensities ranging between about 5 and 65 hounsfield units hu while chronic emboli have ranged between about 30 and 150 5 contraindications edit ctpa is less desirable in pregnancy due to the amount of ionizing radiation required which may damage the breasts which are particularly sensitive during pregnancy and because of concerns of the effects of iodine on the fetus thyroid gland 6 v q scans can offer lower radiation doses and may be adapted to further reduce the dose by omitting the lung ventilation portion of the exam they are therefore recommended to be preferentially applied to pregnant patients 7 8 diagnostic algorithms for pulmonary embolism in pregnancy vary however a common compromise is to perform ultrasound testing for deep vein thrombosis of the legs and if this is positive make the diagnosis of pulmonary embolism on the basis of symptoms and presence of the dvt ctpa would then only be performed if exhaustive non radiation based testing could not make a positive diagnosis ctpa is contraindicated in known or suspected allergy to contrast media or in kidney failure where contrast agents could worsen the kidney function 3 acquisition edit the best results are obtained using multidetector computed tomography mdct scanners 9 an intravenous cannula is required for the administration of iodinated contrast the typical dose is 30 40 g of iodine corresponding to 20 30 cc of 370 mg ml iodine solution 10 however for patients at high risk of contrast induced nephropathy it is possible to reduce the required amount of contrast using dual energy ct with such a protocol only 7 10 g of iodine 20 30 cc of 370 mg ml iodine solution may be needed 10 many hospitals use bolus tracking where the scan commences when the contrast is detected at the level of the proximal pulmonary arteries if this is done manually scanning commences about 10 12 seconds after the injection has started slices of 1 3 mm are performed at 1 3 mm intervals depending on the nature of the scanner single versus multidetector 3 high contrast flow rate of 4ml sec through 18g branula at antecubital fossa is recommended to achieve optimal quality images however for those with peripheral arterial disease and those with central venous catheter with low flow rate 2 0 to 2 5 ml sec are still manage to produce acceptable images 11 state of the art modern ct scanners with a scan rate of up to 320 mm s can acquire all the images within a 1 second x ray exposure avoiding the problems of respiratory motion cardiac motion and contrast draining from the pulmonary circulation during the study even though the actual scan may be completed in 1 second or less considerable staff and patient time is required for preparation of the contrast agent positioning on the scanner and planning the scan this is particularly the case as patients undergoing ctpa are frequently seriously unwell requiring oxygen treatment and or close monitoring interpretation edit on ctpa the pulmonary vessels are filled with contrast and appear white any mass filling defects embolus or other matter such as fat appears darker ideally the scan should be complete before the contrast reaches the left side of the heart and the aorta as this may mean contrast has drained from the pulmonary arteries or require a larger dose of contrast media 12 other from assessing any filing defect within the pulmonary trunk and its segmental branches the diameter of the right heart can be compared with diameter of the left heart the right heart diameter should not be more than the diameter of left heart normally the interventricular septum should mildly bulge into the right ventricle due to high pressure within the left ventricle any reverse bulge or flattening of the interventricular septum indicates pulmonary hypertension 12 pericardial effusion may also be seen in pulmonary hypertension thickening of pericardium more than 4 mm or pericardial calcification indicates constrictive pericarditis 12 references edit 1 2 3 fedullo pf tapson vf september 2003 clinical practice the evaluation of suspected pulmonary embolism the new england journal of medicine 349 13 1247 1256 doi 10 1056 nejmcp035442 pmid 14507950 s2cid 45911346 apfaltrer p hanna el henzler t fink c schoepf uj 6 october 2011 ct imaging of pulmonary embolism current status current cardiovascular imaging reports 4 6 476 484 doi 10 1007 s12410 011 9112 6 1 2 3 anderson dr kahn sr rodger ma kovacs mj morris t hirsch a et al december 2007 computed tomographic pulmonary angiography vs ventilation perfusion lung scanning in patients with suspected pulmonary embolism a randomized controlled trial jama 298 23 2743 2753 doi 10 1001 jama 298 23 2743 pmid 18165667 venous thromboembolic diseases diagnosis management and thrombophilia testing national institute for health and care excellence november 2015 retrieved 27 january 2017 wittram c maher mm halpern ef shepard ja june 2005 attenuation of acute and chronic pulmonary emboli radiology 235 3 1050 1054 doi 10 1148 radiol 2353040387 pmid 15833986 scarsbrook af gleeson fv february 2007 investigating suspected pulmonary embolism in pregnancy bmj 334 7590 418 419 doi 10 1136 bmj 39071 617257 80 pmc 1804186 pmid 17322258 konstantinides sv torbicki a agnelli g danchin n fitzmaurice d galiè n et al november 2014 2014 esc guidelines on the diagnosis and management of acute pulmonary embolism european heart journal 35 43 3033 69 3069a 3069k doi 10 1093 eurheartj ehu283 pmid 25173341 pahade jk litmanovich d pedrosa i romero j bankier aa boiselle pm 2009 quality initiatives imaging pregnant patients with suspected pulmonary embolism what the radiologist needs to know radiographics 29 3 639 654 doi 10 1148 rg 293085226 pmid 19270072 s2cid 207733905 schoepf uj goldhaber sz costello p may 2004 spiral computed tomography for acute pulmonary embolism circulation 109 18 2160 2167 doi 10 1161 01 cir 0000128813 04325 08 pmid 15136509 1 2 janet cochrane miller 2015 dual energy ct imaging for suspected pulmonary embolism using a lower dose of contrast agent radiology rounds a newsletter for referring physicians massachusetts general hospital department of radiology 13 7 archived from the original on 2017 05 10 retrieved 2018 02 05 gossner j 2012 09 25 feasibility of computed tomography pulmonary angiography with low flow rates journal of clinical imaging science 2 57 doi 10 4103 2156 7514 100999 pmc 3515945 pmid 23230539 1 2 3 lewis g hoey et reynolds jh ganeshan a ment j june 2015 multi detector ct assessment in pulmonary hypertension techniques systematic approach to interpretation and key findings quantitative imaging in medicine and surgery 5 3 423 432 doi 10 3978 j issn 2223 4292 2015 01 05 pmc 4426108 pmid 26029645 v t e angiography angiography cardiac catheterization microangiography cerebral angiography pulmonary angiography ct pulmonary angiogram cholangiography computed tomography angiography magnetic resonance angiography digital subtraction angiography fluorescein angiography carbon dioxide angiography v t e medical imaging x ray radiography 2d pneumoencephalography dental radiography sialography myelography cxr bronchography axr kub dxa dxr upper gastrointestinal series small bowel follow through lower gastrointestinal series cholangiography cholecystography mammography pyelogram cystography arthrogram hysterosalpingography skeletal survey angiography angiocardiography aortography venography lymphogram orbital x ray ct scan techniques general operation quantitative high resolution x ray microtomography electron beam cone beam proton targets heart calcium scan angiography abdominal and pelvis virtual colonoscopy angiography coronary pulmonary head thyroid whole body imaging full body ct scan other fluoroscopy dental panoramic radiography x ray motion analysis hounsfield scale radiodensity g arm mri brain functional neurography cardiac perfusion angiography cholangiopancreatography mrcp breast sequences diffusion restriction tractography synthetic mri ultrasound techniques doppler contrast enhanced 3d endoscopic duplex echocardiography doppler echocardiography tte tee ice transcranial doppler intravascular gynecologic obstetric echoencephalography abdominal ultrasonography liver tumors renal renal tract rectal breast scrotal carotid emergency ultrasound fast pre hospital radionuclide 2d scintigraphy cholescintigraphy scintimammography ventilation perfusion scan radionuclide ventriculography radionuclide angiography radioisotope renography sestamibi parathyroid scintigraphy radioactive iodine uptake test bone scintigraphy immunoscintigraphy dacryoscintigraphy dmsa scan gastric emptying study full body octreotide scan gallium 67 scan ga 68 dotatoc indium 111 wbc scan 3d ect spect gamma ray myocardial perfusion imaging pet positron brain pet cardiac pet pet mammography pet ct pet mri optical laser optical tomography optical coherence tomography confocal microscopy endomicroscopy orthogonal polarization spectral imaging thermography non contact thermography contact thermography dynamic angiothermography target conditions acute stroke pregnancy category v t e tests and procedures involving the respiratory system surgery upper rt nose rhinoplasty septoplasty somnoplasty alarplasty rhinectomy rhinomanometry acoustic rhinometry sinus sinusotomy larynx laryngoscopy laryngectomy laryngotomy thyrotomy laryngotracheal reconstruction lower rt trachea cricothyrotomy tracheoesophageal puncture tracheotomy bronchus bronchoscopy lung pneumonectomy lobectomy wedge resection transplantation decortication heart lung transplant chest wall pleura mediastinum and diaphragm pleura pleural cavity thoracentesis pleurodesis thoracoscopy thoracotomy chest tube mediastinum mediastinoscopy nuss procedure tests medical imaging bronchography ct pulmonary angiogram high resolution computed tomography spiral ct ventilation perfusion scan clinical prediction rule pneumonia severity index curb 65 lung function test body plethysmography spirometry bronchial challenge test capnography diffusion capacity impulse oscillometry cytology bronchoalveolar lavage nasopharyngeal swab sputum culture other blood gas test pneumography other procedures oxygen therapy intubation surgical airway management mechanical ventilation negative pressure ventilator positive pressure ventilation respiratory therapy artificial respiration cpr hyperbaric medicine decompression chamber heliox nebulizer postural drainage hyperinflation therapy pulmonary hygiene pulmonary rehabilitation retrieved from https en wikipedia org w index php title ct_pulmonary_angiogram oldid 1371858773 categories diagnostic radiology respiratory system imaging x ray computed tomography ct imaging techniques hidden categories articles with short description short description matches wikidata short description is different from wikidata this page was last edited on 28 august 2026 at 23 03 utc page was rendered with parsoid text is available under the creative commons attribution sharealike 4 0 license additional terms may apply by using this site you agree to the terms of use and privacy policy wikipedia is a registered trademark of the wikimedia foundation inc a non profit organization privacy policy about wikipedia disclaimers contact wikipedia legal safety contacts code of conduct developers statistics cookie statement mobile view search search toggle the table of contents ct 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