CASE: Artifact, not PE

EXAM QUALITY:

MODERATE

1. Can clearly see to the segmental level, allowing for typical artifacts limiting evaluation of some segmental branches
2. ROI on main PA = 448 HU (ROI > 300 HU is often high quality if no/minimal limitation. However, here there is major limitation affecting the subsegmental level, so it is moderate quality.)
3. LIMITATIONS:

• Streak artifact from dense contrast in the SVC
• Pulmonary motion artifact

PE FINDINGS:

NO PE.

ARTIFACT in right upper lobe

• Segmental PA filling defect is due to combination of both streak and pulmonary motion artifacts.
• Pulmonary motion artifact results in volume averaging: Note the ghosting of vessels best seen on lung windows
• And there is also streak artifact, that is oblique to long axis of vessel on coronal plane
• This filling defect has an ROI density of 28 HU. If ROI density ≤ 125 HU, it may be PE or artifact, so not helpful for distinction.
• F/u CT PE exam 3 days later shows no PE

ANCILLARY FINDINGS:

None.

IMPRESSION:

No pulmonary embolism on this moderate-quality exam.

CREATED BY:

Arun Nachiappan MD, Ali Dhanaliwala MD, Sophia O'Brien MD.

Questions or comments? Please contact narun@upenn.edu