PURPOSE: To determine whether CTPA accurately portrays right ventricular (RV) and pulmonary artery (PA)dilatation and to correlate these findings with echocardiographic data in patients with central PE.
METHODS: We retrospectively reviewed data of consecutive patients with central PE diagnosed by CTPA at our institution over a 3 year period. We recorded demographic parameters, clinical findings at presentation, CTPA and echocardiographic data. CTPA and echo measurements of RV size and RV/LV ratio were obtained. Main PA size was obtained from CTPA and evaluation for deep vein thrombosis (DVT) was determined from the venous phase of the CT (CTV).
RESULTS: Thirty five patients (16=F) with central PE were identified. Mean age was 58 years (range 31-86).Only 3 patients had hypotension and all improved with iv fluids. EKG showed sinus tachycardia in 88%, S1Q3T3 pattern in 24%, and ST-T-wave changes in 32%. CTPA showed saddle emboli in 4 and bilateral main thrombi in 17 patients. Echocardiograms within 48 hours of CTPA were available in 18 patients. RV/LV ratios were 1.0 or greater on CTPA in 77% of patients and the RV/LV ratio correlated with echo data(r=0.68, p=0.006). PA enlargement (>30mm) by CT was present 67%. Mean PA size was 31 mm (range 25-39). Estimated RV pressure (RVSP) by echo, when available, averaged 44 mm Hg (range 20-69) but there was no correlation between PA size and RVSP. More patients with abnormal EKG's had RV/LV ratio > 1 on CTPA (9/14) than on echo (6/14). Abnormal findings on EKG were not associated with elevated RVSP or RV enlargement on echo. DVT was documented in 17 patients.
CONCLUSION: CTPA /CTV provides useful information about RV dilatation and enlargement of the PA, as well as confirming the presence of DVT with a single study. RV enlargement and an RV/LV > 1 on CTPA correlate well with echocardiographic findings and are available without further studies.
CLINICAL IMPLICATIONS: In patients with central PE,CTPA can reliably identify RV and PA enlargement and may obviate the need for echocardiogram.
DISCLOSURE: Maritza Groth, No Financial Disclosure Information; No Product/Research Disclosure Information