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Radiology
Pulmonary Embolism
Built from Fundamentals of Diagnostic Radiology
What’s inside
6 sections · 92 slides
Introduction
What acute PE is, why it matters, and the three severity categories
- What acute pulmonary embolism is
- Why PE matters
- Post-PE syndrome
- Three categories of acute PE
- <1%
- Escalating treatment beyond anticoagulation
Evaluation and Risk Stratification
Diagnosis, right-heart assessment, biomarkers, and severity scores
- Diagnosing PE
- PE response teams
- Clinical parameters in PE assessment
- Clinical parameters in PE assessment (continued)
- Predictors of short-term mortality
- Echocardiography in PE
- RV strain on imaging
- Massive PE: CT, echo, and angiography
- Cardiac biomarkers
- PESI and sPESI scores
- PESI and sPESI scoring systems
- PESI and sPESI scoring systems (continued)
- Guideline risk categories
- Acute PE risk stratification
Management of Acute PE
Anticoagulation first, then escalation for massive and submassive disease
- Anticoagulation is first-line
- Managing low-risk PE
- Managing massive (high-risk) PE
- Managing submassive (intermediate-risk) PE
- Intermediate-risk PE management directions
- Management algorithm for acute PE
Catheter-Directed Therapy
Low-dose thrombolysis delivered into the clot, plus mechanical removal
- Catheter-directed therapy (CDT) concept
- The three CDT trials
- CDT knowledge gaps
- Contrast reaction risk
- Pulmonary hypertension
- Angiography technique with high pressures
- Left bundle branch block
- Bleeding risk and consensus
- Contraindications to catheter-directed thrombolysis
- Advance planning
- Team and equipment readiness
- Interventional PE treatment tray equipment
- Interventional PE treatment tray equipment (continued)
- Goal in massive PE
- Mechanical thrombectomy in massive PE
- Mechanical thrombectomy techniques
- Aspiration thrombectomy with the CT 8 device
- Pharmacomechanical thrombectomy
- Access and angiography
- Rotating pigtail fragmentation
- Adjunctive aspiration
- Why avoid mechanical fragmentation here
- How infusing into the clot works
- CDT delivery catheters
- Ultrasound-assisted vs standard CDT
- Catheter-directed thrombolysis in submassive PE
- CDT access and sheaths
- CDT dosing
Postprocedural Care and Follow-Up
Monitoring, anticoagulation, and long-term follow-up after intervention
- Structured postprocedural care
- Monitoring fibrinogen
- Postprocedural infusion instructions
- Heparin during CDT
- Outpatient follow-up
IVC Filters
Trapping clot in the inferior vena cava when anticoagulation cannot
- What an IVC filter does
- IVC filter designs
- IVC filter designs (continued)
- Permanent vs optional filters
- Venogram after Crux filter placement
- Three indication groups
- Indications for IVC filters
- Indications for IVC filters (continued)
- Guideline support
- IVC filter contraindications
- Coagulopathy and contrast issues
- Venous anatomy and delivery
- Venous anatomy variations of the abdomen and pelvis
- Where to place the filter
- IVC filter placement venography
- Measuring the IVC
- Suprarenal filter for IVC thrombus
- Suprarenal filter for IVC thrombus
- Two types of complications
- Complications of IVC filter placement
- Follow-up and retrieval
- Key takeaways
- Suggested readings
- Suggested readings
- Suggested readings
- Suggested readings
- Suggested readings
- Suggested readings
- Suggested readings
- Suggested readings
- Suggested readings
- Suggested readings
- Brant and Helms' Fundamentals of Diagnostic Radiology