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Air Trapping on CT of Patients with Pulmonary Embolism

Hiroaki Arakawa1,2, Yasuyuki Kurihara1, Kaoru Sasaka1, Yasuo Nakajima1 and W. Richard Webb3

1 Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki City, 216-8511 Japan.
2 Present address: Department of Radiology, Dokkyo University School of Medicine, Mibu, Shimotsuga-gun, Tochigi, 321-0293 Japan.
3 Department of Radiology, University of California San Francisco, 505 Parnassus Ave., San Francisco, CA 94143-0628.



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  		Fig. 1A. —Acute pulmonary embolism in 76-year-old woman. Helical CT angiogram (3-mm collimation) shows clot (arrowhead) in posterior segmental arteries of right upper lobe. Clot was not identified in arteries of left upper lobe.

 


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  		Fig. 1B. —Acute pulmonary embolism in 76-year-old woman. Helical CT angiogram obtained using lung window settings shows inhomogeneous lung attenuation (arrows) in both upper lobes. Vessel size in lower attenuation areas is only slightly reduced, thus indicating mosaic perfusion as possible cause of inhomogeneous lung attenuation.

 


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  		Fig. 1C. —Acute pulmonary embolism in 76-year-old woman. Expiratory high-resolution CT scan obtained at same level as B shows air trapping to be associated with mosaic perfusion in both upper lobes. Air trapping in left upper lobe closely corresponds to area of low attenuation seen on inspiratory scan (B). In right upper lobe, area of air trapping appears larger than area of mosaic perfusion seen on inspiratory scan.

 


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  		Fig. 2A. —Acute embolism in 68-year-old woman with deep vein thrombosis. Helical CT angiogram shows massive thromboembolism in right descending pulmonary artery and its branches in lower lobes. Clot (arrow) is also visualized in artery leading to left lingula. Clot was also identified in segmental arteries in left lower lobe (not shown).

 


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  		Fig. 2B. —Acute embolism in 68-year-old woman with deep vein thrombosis. Helical CT angiogram obtained using lung window settings shows inhomogeneous lung attenuation with peripheral ground-glass opacity (arrows) in both lower lobes.

 


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  		Fig. 2C. —Acute embolism in 68-year-old woman with deep vein thrombosis. Expiratory high-resolution CT scan obtained at same level as B shows multifocal areas of air trapping distal to arteries with clots.

 


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  		Fig. 3A. —Acute embolism in 61-year-old woman with chronic pulmonary embolism. Helical CT angiogram shows eccentric clots (arrows) in both lower lobe pulmonary arteries.

 


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  		Fig. 3B. —Acute embolism in 61-year-old woman with chronic pulmonary embolism. Helical CT angiogram obtained using lung window settings shows near normal lung attenuation. Focal pleural-based ground-glass attenuation (arrow) is visible in right lower lobe.

 


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  		Fig. 3C. —Acute embolism in 61-year-old woman with chronic pulmonary embolism. Expiratory high-resolution CT scan obtained at same level as B shows extensive areas of air trapping (arrows) distal to arteries with clots.

 


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  		Fig. 4A. —Acute pulmonary embolism in 45-year-old woman. Helical CT angiogram obtained at level between aortic arch and tracheal carina shows clot (arrowhead) in segmental artery of right upper lobe, but no clot was identified in left side.

 


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  		Fig. 4B. —Acute pulmonary embolism in 45-year-old woman. Helical CT angiogram obtained above aortic arch using lung window settings shows small area of lower attenuation (arrows) in left upper lobe.

 


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  		Fig. 4C. —Acute pulmonary embolism in 45-year-old woman. Expiratory high-resolution CT scan obtained at same level as B shows extensive areas of air trapping in both upper lobes (arrows). Areas of air trapping are more widespread than areas of mosaic perfusion shown on B.

 

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