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Comparison of Interpretations of CT Angiograms in the Evaluation of Suspected Pulmonary Embolism by On-Call Radiology Fellows and Subsequently by Radiology Faculty

Michelle S. Ginsberg1,2, Valencia King2 and David M. Panicek1,2

1 Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.
2 Weill Medical College of Cornell University, 1300 York Ave., New York, NY 10021.



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  		Fig. 1. —39-year-old woman with hepatoma and shortness of breath. Axial CT angiogram shows small filling defect (arrow) in posterior segmental pulmonary artery branch of right upper lobe. Interpretation by fellow was negative for pulmonary embolus, and interpretation of attending radiologist was small pulmonary embolus in posterior segmental pulmonary artery branch of right upper lobe. Study radiologists agreed with interpretation of attending radiologist. Evaluation of images was limited by presence of streak artifact (arising from dense IV contrast material in superior vena cava) crossing truncus anterior, but filling defect was clearly evident in posterior segmental branch.

 


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  		Fig. 2. —68-year-old woman with lung cancer. Axial CT angiogram shows small filling defect (arrow) in subsegmental pulmonary artery branch in left lower lobe. Interpretation of fellow was negative for pulmonary embolus; interpretation of attending radiologist was small subsegmental pulmonary embolus in left lower lobe. Study radiologists agreed with interpretation of attending radiologist.

 


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  		Fig. 3A. —64-year-old woman with breast cancer. Axial CT angiogram shows filling defect (arrows) in right pulmonary artery considered by study radiologists to represent direct invasion of artery by adjacent anterior mediastinal and pericardial tumor, rather than bland thrombus. Interpretation of fellow was positive for pulmonary embolus, and interpretation of attending radioligist was negative for bland thrombus, with anticoagulation therapy not required.

 


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  		Fig. 3B. —64-year-old woman with breast cancer. Axial CT angiogram obtained at more caudal level than A shows filling defect (arrow) in right pulmonary artery nearly completely outlined by IV contrast material.

 

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