Nonthrombotic Pulmonary Emboli
Santiago E. Rossi1,2,
Philip C. Goodman1 and
Tomas Franquet3
1
Department of Radiology, Duke University Medical Center, Box 3808, Erwin St.,
Durham, NC 27710.
2
Present address: Department of Radiology, Fundacion Dr. "Enrique
Rossi," Arenales 2777, C P: 1425, Buenos Aires, Argentina.
3
Department of Radiology, Hospital de Sant Pau, Universidad Autonoma de
Barcelona, Sant Antoni M. Claret 167, 08025, Barcelona, Spain.
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Fig. 1. —34-year-old male IV drug user with septic embolism, shortness of
breath, and fever. Posteroanterior chest radiograph shows peripheral bilateral
poorly marginated nodules.
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Fig. 2. —33-year-old female IV drug user with septic embolism and fever.
Posteroanterior chest radiograph shows bilateral peripheral thick- and
irregular-walled cavitary nodules.
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Fig. 3. —56-year-old man with septic embolism and deep venous thrombosis of
lower extremities. Patient presented with dyspnea, fever, and chills. CT scan
(lung window) shows bilateral peripheral cavitary nodules and confirmed
right-sided pleural effusion.
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Fig. 4A. —57-year-old woman with catheter embolism and breast cancer. Patient
had part of right subclavian venous line shear off when catheter was being
removed. Posteroanterior chest radiograph shows right subclavian central
venous catheter with tip in superior vena cava.
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Fig. 4B. —57-year-old woman with catheter embolism and breast cancer. Patient
had part of right subclavian venous line shear off when catheter was being
removed. Posteroanterior (B) and lateral (C) chest radiographs
show catheter fragment (arrows) in posterior segment of right upper
lobe.
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Fig. 4C. —57-year-old woman with catheter embolism and breast cancer. Patient
had part of right subclavian venous line shear off when catheter was being
removed. Posteroanterior (B) and lateral (C) chest radiographs
show catheter fragment (arrows) in posterior segment of right upper
lobe.
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Fig. 4D. —57-year-old woman with catheter embolism and breast cancer. Patient
had part of right subclavian venous line shear off when catheter was being
removed. CT scan (mediastinal window) reveals catheter fragment in right
pulmonary artery.
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Fig. 4E. —57-year-old woman with catheter embolism and breast cancer. Patient
had part of right subclavian venous line shear off when catheter was being
removed. Pulmonary angiogram shows catheter fragment in right upper lobe
pulmonary artery. Catheter was removed using 35-mm snare device.
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Fig. 5A. —34-year-old man with fat embolism and many injuries from motor
vehicle collision. Patient experienced new respiratory problems 72 hr later.
Anteroposterior radiograph of right femur reveals transverse fracture.
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Fig. 5B. —34-year-old man with fat embolism and many injuries from motor
vehicle collision. Patient experienced new respiratory problems 72 hr later.
Anteroposterior chest radiographs obtained 24 (B) and 72 hr (C)
after A show increase in diffuse heterogeneous opacities in both lungs,
consistent with edema caused by fat embolism.
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Fig. 5C. —34-year-old man with fat embolism and many injuries from motor
vehicle collision. Patient experienced new respiratory problems 72 hr later.
Anteroposterior chest radiographs obtained 24 (B) and 72 hr (C)
after A show increase in diffuse heterogeneous opacities in both lungs,
consistent with edema caused by fat embolism.
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Fig. 6. —40-year-old asymptomatic man with incidental air embolism. CT scan
(mediastinal window) shows air in left brachiocephalic vein (arrow)
after IV contrast injection for contrast-enhanced chest CT.
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Fig. 7. —48-year-old man with air embolism and trauma to right chest, causing
communication between large bronchus and adjacent pulmonary vein.
Posteroanterior chest radiograph reveals radiolucency representing air in
heart. Patient died soon after scanning.
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Fig. 8. —32-year-old man with air embolism that disconnected patient's
central venous line. Anteroposterior chest radiograph shows bell- or
coned-shaped radiolucency (arrow) in main pulmonary artery.
Hyperlucent upper lobes result from oligemia caused by obstruction of
pulmonary artery by air emboli. (Reprinted with permission from
[11])
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Fig. 9. —33-year-old woman with amniotic fluid embolism. Patient was not
responsive to induction of labor and proceeded to cesarean delivery. While
uterus was being sutured, patient had tonic-clonic seizure followed by cardiac
arrest. Supportive measures were instituted, but patient died 3 weeks later.
Anteroposterior chest radiograph obtained shortly after cesarean delivery
reveals mild cardiomegaly and bilateral lung opacities that are denser on left
side. Findings were attributed to asymmetric pulmonary edema caused by
presumed amniotic fluid embolism.
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Fig. 10. —48-year-old woman with tumor embolism and history of stage IIIB
carcinoma of uterine cervix. Patient presented with increasing dyspnea on
exertion, cough, and occasional hemoptysis. CT scan (lung window) shows
bilateral peripheral pulmonary opacities, some wedge-shaped, suggesting
pulmonary infarcts. Autopsy confirmed multiple tumor emboli in pulmonary
circulation. (Courtesy of Haramati LB, Bronx, NY)
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Fig. 11A. —70-year-old woman with tumor embolism and adenocarcinoma of unknown
primary source. Patient presented with acute dyspnea and shortness of breath.
Anteroposterior chest radiograph shows mild cardiomegaly and normal lungs.
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Fig. 11B. —70-year-old woman with tumor embolism and adenocarcinoma of unknown
primary source. Patient presented with acute dyspnea and shortness of breath.
99mTc macroaggregated albumin radionuclide perfusion scan reveals
numerous peripheral wedge-shaped perfusion defects, characteristic of tumor
emboli. Autopsy confirmed tumor emboli in pulmonary circulation. LPO = left
posterior oblique, POST = posterior, RPO = right posterior oblique, RAO =
right anterior oblique, ANT = anterior, LAO = left anterior oblique.
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Fig. 12A. —26-year-old female drug user with talc embolism. Patient had
injected dissolved methylphenidate hydrochloride tablets IV and presented with
long-standing pulmonary hypertension. Posteroanterior chest radiograph shows
fine reticular opacities in lower lobes and large central pulmonary
arteries.
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Fig. 12B. —26-year-old female drug user with talc embolism. Patient had
injected dissolved methylphenidate hydrochloride tablets IV and presented with
long-standing pulmonary hypertension. Coned-down radiograph of left lower lobe
shows fine reticular pattern.
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Fig. 13A. —31-year-old man with mercury embolism. Patient injected mercury IV.
Posteroanterior chest radiograph shows multiple fine round metallic opacities
in both lungs. In medial right lung, round opacities line up in direction of
right lower lobe pulmonary artery.
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Fig. 13B. —31-year-old man with mercury embolism. Patient injected mercury IV.
Anteroposterior abdominal radiograph with patient supine shows multiple
metallic opacities in liver, kidneys, ureters, and bladder.
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Fig. 14. —53-year-old man with iodinated contrast embolism. After
lymphangiography, patient complained of shortness of breath. Coned-down
radiograph of left upper lobe shows fine diffuse reticulonodular opacities.
Contrast material is also present in left supraclavicular lymph nodes.
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Fig. 15. —22-year-old female IV drug user with cotton embolism and shortness
of breath. Patient typically used cotton balls to clean her skin and inserted
needle through cotton while injecting narcotics. Posteroanterior chest
radiograph reveals multiple poorly marginated hazy and homogeneous opacities
in both lungs. Open lung biopsy results revealed chronic inflammatory reaction
and refractile cotton fibers.
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Fig. 16A. —22-year-old woman with hydatid embolism and history of pulmonary
hydatid disease. Patient presented with 6-month history of dyspnea on exertion
and hemoptysis. Contrast-enhanced CT scan (mediastinal window) reveals
hypodense material in lower lobe pulmonary arteries. (Reprinted with
permission from [48])
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Fig. 16B. —22-year-old woman with hydatid embolism and history of pulmonary
hydatid disease. Patient presented with 6-month history of dyspnea on exertion
and hemoptysis. Contrast-enhanced CT scan (lung window) reveals marked
dilatation of pulmonary arteries resulting from intravascular embolized
material.
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