Acute central thromboembolic disease: posttherapeutic follow-up with spiral CT angiography

To evaluate the resolution of acute central pulmonary embolism (PE).

Sixty-two patients with angiographic (n = 43) or spiral computed tomographic (CT; n = 19) diagnosis of acute central PE underwent spiral CT after a mean of 11 months. CT signs of unresolved acute or chronic PE at the level of the central pulmonary arteries were recorded. A scoring system enabled quantification of endoluminal abnormalities at the time of diagnosis and follow-up.

At follow-up, 30 patients (group 1; 48%) had complete resolution of acute PE; 32 patients (group 2; 52%) showed endovascular abnormalities (mean follow-up in both groups, 10.5 months). Whereas clinical presentation, risk factors at diagnosis, and therapeutic modalities did not differ statistically significantly between the two groups, group 2 had more extensive acute PE at diagnosis than did group 1. In group 2, CT showed an incomplete resolution of acute PE in 24 patients (group 2a; 39%) and development of chronic PE in eight patients (group 2b; 13%). Six patients had exertional dyspnea (five group 2a patients and one group 2b patient); five patients had echocardiographically demonstrated pulmonary hypertension (all group 2a patients).

Spiral CT enabled noninvasive detection of unresolved PE and of newly developed chronic PE.