Pulmonary Embolism Detection Without Invasive Procedures

For purposes of diagnosis, I believe that spiral CT should be treated in the same fashion as pulmonary angiography. A clear demonstration of the actual embolus should be made before calling a test positive. Thus, a vascular filling defect or cutoff vessel is necessary in order to diagnose pulmonary embolism (Fig. 1). Focal oligemia or decreased areas of pulmonary parenchymal attenuation and the possibility of pulmonary infarction suggested by a wedge-shaped opacity in the periphery of lung are not, by themselves, sufficient for diagnosis. Filling defects in the main, right, and left pulmonary arteries are clear even to the casual observer. In fact, segmental branch filling defects or cutoff vessels are also easily identified. In some instances subsegmental and even smaller pulmonary emboli are well delineated, but in these smaller vessels the diagnosis may not always be as reliable. A large number of articles have addressed the accuracy and value of spiral CT, and this is the topic of the next section.

From Mike:
This is a noninvasive technique with a great deal of diagnostic promise. From the looks of this article, some day this technique might add another key factor in measuring optimal lung function or at least, lung function that is at risk; before serious illness presents itself. An ounce of prevention is worth a pound of cure. I ask them to raise their insights and standards as to what optimal breathing function looks, feels and sounds like.

Reprint request Dr. Philip Goodman, Dept. of Radiology, 1515A Hospital North, Box 3808, Duke University, Durham, NC 27710. E-mail goodm008@mc.duke.edu