Embolic Disease Introduction

Embolic Disease

Author

Definition

Embolic disease is …

characterized by …..

caused by ..etiology or predisposing factors

resulting in a pathological feature (structural change or functional change) or clinical feauture

Sometimes complicated by ….

Diagnosis is suspected clinically by … and confirmed by ….

Imaging includes the use of

Treatment options depend on …. but includes …..

Etymology if available

Principles

Reticuloendothelial System

Cerebellar and Parietal Lobe Involvement

71239c04 patient with atrial fibrillation brain cerebrum cerebelum cerebellar hemisphere multicentric parietal lobe parasagittal hemorrhagic infarct paracentral DWII bright T2 bright FLAIR bright GRE mixed blood products dx acute hemorrhagic infarction secondary to embolic event the patient disd have other non hemorrhagic infrctions in other parts of the brain MRI Davidoff MD 71239c0171239c02 71239c03 71239c04

Emboli to the Posterior Circulation Involving the Cerbellum and the Occipital Cortex

74923c01 brain emboli low density lesions posterior cerebral circulation cerebellum occipital lobe occipital infarcts cerebellar infarcts embolic disease CTscan Courtesy Ashley DAvidoff MD

Embolic Infarct of the Splenic Artery

47640 spleen artery fx wedge shaped defect fx occluded artery dx embolism embolic infarction CTscan Davidoff MD

Wedge Shaped Infarct in the Spleen

The CTscan with contrast shows a wedge shaped defect in the spleen (overlaid in pink in middle image) characteristic of an acute infarction most commonly caused by emboli. The pathology image from a different patient shows the same wedge shaped process.

46774c01 21321spleen splenic fx wedge shaped defects dx emboli dx systemic embolization dx splenic infarcts CTscan Davidoff MD

Breast Carcinoma and Pulmonary Emboli

This CT is from an elderly lady wih breast carcinoma, who presents with SOB . Noted are filling defects in the pulmonary arteries (white arrow). The left sided pulmonary arteries also have filling defects. (see next set of images) She has had a left mastectomy, (green arrow) and has lytic metastases of the left ribs with destruction of the bone which remain as two white calcific specks (teal blue arrow). A small pleural effusion on the left may be due to the malignancy (likely) or due to the pulmonary embolus.

Pulmonary Emboli Before and After Treatment

The patient has breast carcinoma and was shown in the set of images above. She presented with shortness of breath and pulmonary emboli were diagnosed as filling defects (overlay in royal blue c), in all the visualized vessels. After 2 weeks of anticiacougulant therapy the emboli were lysed and the vessels were completely patent (overlaid in red in d)

PE from Upper Limb Thrombosis

This elderly woman presented with acute respiratory difficulty with swelling of her left upper limb. CT shows extensive pulmonary embolic disease to the lower lobes from second order branches to the tertiary branches (1-4 with green overlay) and evidence of thrombosis of the left subclavian vein. (5,6). Swelling over the anterior chest including the pectoralis muscles is evident in 7. Courtesy Priscilla Slanetz MD. 32538cLW

Football Player with a Comminuted Fracture and Fat Embolism

21 year old college student and football player who sustained a compound fracture of his right tibia and fibula. While awaiting surgery he became short of breasth, tachpneic and tachycardic and his saturations dropped to 70’s from 90’s on room air. He had a fever to 103, heart rate of 100, respiratory rate of 30, and a systolic pressure of 140. He required intubation for 5 days but did recover thereafter.

Tell the Story

43684c01.8s The series of CTscans are from an elderly lady who presents with chest pain and right leg pain lung fx infiltrate artery lung pulmonary embolus pulmonary atelectasis vs infarction PE PFO heart patent foramen ovale tricuspid regurgitation acute pulmonary hypertension TR kidney embolic infarction aorta embolus embolic disease right to left shunt imaging radiology CTscan Courtesy Ashley Davidoff MD copyright 2009 all rights reserved 43666 43670 43672 43675 43680 43683 5star

The Findings

43684c06b.8s The series of CTscans are from an elderly lady who presents with chest pain and right leg pain lung fx infiltrate artery lung pulmonary embolus pulmonary atelectasis vs infarction PE PFO heart patent foramen ovale tricuspid regurgitation acute pulmonary hypertension TR kidney embolic infarction aorta embolus embolic disease right to left shunt imaging radiology CTscan Courtesy Ashley Davidoff MD copyright 2009 all rights reserved 43666 43670 43672 43675 43680 43683 5star

One Circulation

43684c06b02.8s The series of CTscans are from an elderly lady who presents with chest pain and right leg pain lung fx infiltrate artery lung pulmonary embolus pulmonary atelectasis vs infarction PE PFO heart patent foramen ovale tricuspid regurgitation acute pulmonary hypertension TR kidney embolic infarction aorta embolus embolic disease right to left shunt imaging radiology CTscan Courtesy Ashley Davidoff MD copyright 2009 all rights reserved 43666 43670 43672 43675 43680 43683 5star

The Other Circulation

43684c05b01.8s The series of CTscans are from an elderly lady who presents with chest pain and right leg pain lung fx infiltrate artery lung pulmonary embolus pulmonary atelectasis vs infarction PE PFO heart patent foramen ovale tricuspid regurgitation acute pulmonary hypertension TR kidney embolic infarction aorta embolus embolic disease right to left shunt imaging radiology CTscan Courtesy Ashley Davidoff MD copyright 2009 all rights reserved 43666 43670 43672 43675 43680 43683 5star

15551b01

15551b01 bone heart cardiac pulmonary artery tumor pulmonary emboli 15537 T2 intensity over the heart T2 hyperintensity over left humerus shoulder MRIscan DxChondrosarcoma of the humerus metatstattic to the heart lungs Davidoff MD

15537b04

15537b04 hx 75F with left shoulder pain heart lung fx calcification fx parenchymal infiltrate fx pleural effusion dx small pulmonary infarct small Hamptons hump dx metastatic chondrosarcoma metastasis osteogenic sarcomatous malignant pulmonary emboli embolus imaging radiology CTscan Courtesy Ashley Davidoff MD

15537b04d

15537b04d hx 75F with left shoulder pain heart lung fx calcification fx parenchymal infiltrate fx pleural effusion dx small pulmonary infarct small Hamptons hump dx metastatic chondrosarcoma metastasis osteogenic sarcomatous malignant pulmonary emboli embolus imaging radiology CTscan Courtesy Ashley Davidoff MD

24137

24137 lung pulmonary fx AVM fx arteriovenous malformation dx cirrhosis dx hepatopulmonary syndrome liver hepatic pulmonary artery pulmonary vein MIT post embolization pulmonary angiogram arteriogram angiography Courtesy Ashley Davidoff MD

“Hot” Pellet Emboli

29676b.8s 56 year old male with prostate carcinoma has radiation seeds implanted into the prostate gland A chest X-ray following the procedure shows at least 4 of the seeds in the base of the right lung and 2 of the seeds in the mid left lung field. An azygous lobe is of incidental note. embolus emboli XRT radiation seeds prostate prostate carcinoma treatment complication iatrogenic radiologists and detectives acuity comprehension Courtesy Ashley Davidoff MD copyright 2009 all rights reserved

Iatrogenic Embolization of RAdiation Seeds from the Prostate

29676c05.8s 56 year old male with prostate carcinoma has radiation seeds implanted into the prostate gland as seen by the radioopaque pellets in the prostate gland in image a. A chest X-ray following the procedure shows at least 4 of the seeds in the base of the right lung and 2 of the seeds in the mid left lung field overlaid in green (c). Image d is a magnification of the right lower lobe and the seeds are overlaid in green in image e. embolus emboli XRT radiation seeds prostate prostate carcinoma treatment complication iatrogenic Courtesy Ashley Davidoff MD copyright 2009 all rights reserved

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Iatrogenic Embolization of RAdiation Seeds from the Prostate



29676c05.8s 56 year old male with prostate carcinoma has radiation seeds implanted into the prostate gland as seen by the radioopaque pellets in the prostate gland in image a. A chest X-ray following the procedure shows at least 4 of the seeds in the base of the right lung and 2 of the seeds in the mid left lung field overlaid in green (c). Image d is a magnification of the right lower lobe and the seeds are overlaid in green in image e. embolus emboli XRT radiation seeds prostate prostate carcinoma treatment complication iatrogenic Courtesy Ashley Davidoff MD copyright 2009 all rights reserved



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Iatrogenic Embolization of RAdiation Seeds from the Prostate



29676c05.8s 56 year old male with prostate carcinoma has radiation seeds implanted into the prostate gland as seen by the radioopaque pellets in the prostate gland in image a. A chest X-ray following the procedure shows at least 4 of the seeds in the base of the right lung and 2 of the seeds in the mid left lung field overlaid in green (c). Image d is a magnification of the right lower lobe and the seeds are overlaid in green in image e. embolus emboli XRT radiation seeds prostate prostate carcinoma treatment complication iatrogenic Courtesy Ashley Davidoff MD copyright 2009 all rights reserved



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“Hot” Pellet Emboli



29676b.8s 56 year old male with prostate carcinoma has radiation seeds implanted into the prostate gland A chest X-ray following the procedure shows at least 4 of the seeds in the base of the right lung and 2 of the seeds in the mid left lung field. An azygous lobe is of incidental note. embolus emboli XRT radiation seeds prostate prostate carcinoma treatment complication iatrogenic radiologists and detectives acuity comprehension Courtesy Ashley Davidoff MD copyright 2009 all rights reserved



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“Hot” Pellet Emboli



29676b.8s 56 year old male with prostate carcinoma has radiation seeds implanted into the prostate gland A chest X-ray following the procedure shows at least 4 of the seeds in the base of the right lung and 2 of the seeds in the mid left lung field. An azygous lobe is of incidental note. embolus emboli XRT radiation seeds prostate prostate carcinoma treatment complication iatrogenic radiologists and detectives acuity comprehension Courtesy Ashley Davidoff MD copyright 2009 all rights reserved



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24137


24137 lung pulmonary fx AVM fx arteriovenous malformation dx cirrhosis dx hepatopulmonary syndrome liver hepatic pulmonary artery pulmonary vein MIT post embolization pulmonary angiogram arteriogram angiography Courtesy Ashley Davidoff MD



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24137 lung pulmonary fx AVM fx arteriovenous malformation dx cirrhosis dx hepatopulmonary syndrome liver hepatic pulmonary artery pulmonary vein MIT post embolization pulmonary angiogram arteriogram angiography Courtesy Ashley Davidoff MD



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15537b04d


15537b04d hx 75F with left shoulder pain heart lung fx calcification fx parenchymal infiltrate fx pleural effusion dx small pulmonary infarct small Hamptons hump dx metastatic chondrosarcoma metastasis osteogenic sarcomatous malignant pulmonary emboli embolus imaging radiology CTscan Courtesy Ashley Davidoff MD



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15537b04d hx 75F with left shoulder pain heart lung fx calcification fx parenchymal infiltrate fx pleural effusion dx small pulmonary infarct small Hamptons hump dx metastatic chondrosarcoma metastasis osteogenic sarcomatous malignant pulmonary emboli embolus imaging radiology CTscan Courtesy Ashley Davidoff MD



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15537b04 hx 75F with left shoulder pain heart lung fx calcification fx parenchymal infiltrate fx pleural effusion dx small pulmonary infarct small Hamptons hump dx metastatic chondrosarcoma metastasis osteogenic sarcomatous malignant pulmonary emboli embolus imaging radiology CTscan Courtesy Ashley Davidoff MD



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15551b01


15551b01 bone heart cardiac pulmonary artery tumor pulmonary emboli 15537 T2 intensity over the heart T2 hyperintensity over left humerus shoulder MRIscan DxChondrosarcoma of the humerus metatstattic to the heart lungs Davidoff MD



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15551b01 bone heart cardiac pulmonary artery tumor pulmonary emboli 15537 T2 intensity over the heart T2 hyperintensity over left humerus shoulder MRIscan DxChondrosarcoma of the humerus metatstattic to the heart lungs Davidoff MD



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The Other Circulation



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The Other Circulation



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43684c06b02.8s The series of CTscans are from an elderly lady who presents with chest pain and right leg pain lung fx infiltrate artery lung pulmonary embolus pulmonary atelectasis vs infarction PE PFO heart patent foramen ovale tricuspid regurgitation acute pulmonary hypertension TR kidney embolic infarction aorta embolus embolic disease right to left shunt imaging radiology CTscan Courtesy Ashley Davidoff MD copyright 2009 all rights reserved 43666 43670 43672 43675 43680 43683 5star



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One Circulation



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The Findings



43684c06b.8s The series of CTscans are from an elderly lady who presents with chest pain and right leg pain lung fx infiltrate artery lung pulmonary embolus pulmonary atelectasis vs infarction PE PFO heart patent foramen ovale tricuspid regurgitation acute pulmonary hypertension TR kidney embolic infarction aorta embolus embolic disease right to left shunt imaging radiology CTscan Courtesy Ashley Davidoff MD copyright 2009 all rights reserved 43666 43670 43672 43675 43680 43683 5star



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The Findings



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Tell the Story



43684c01.8s The series of CTscans are from an elderly lady who presents with chest pain and right leg pain lung fx infiltrate artery lung pulmonary embolus pulmonary atelectasis vs infarction PE PFO heart patent foramen ovale tricuspid regurgitation acute pulmonary hypertension TR kidney embolic infarction aorta embolus embolic disease right to left shunt imaging radiology CTscan Courtesy Ashley Davidoff MD copyright 2009 all rights reserved 43666 43670 43672 43675 43680 43683 5star



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Tell the Story



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Football Player with a Comminuted Fracture and Fat Embolism



21 year old college student and football player who sustained a compound fracture of his right tibia and fibula. While awaiting surgery he became short of breasth, tachpneic and tachycardic and his saturations dropped to 70’s from 90’s on room air. He had a fever to 103, heart rate of 100, respiratory rate of 30, and a systolic pressure of 140. He required intubation for 5 days but did recover thereafter. 
code lung bone fracture fat embolus respiratory distress Courtesy Ashley Davidoff MD copyright 2009 all rights reserved 86255c.8s



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Football Player with a Comminuted Fracture and Fat Embolism



21 year old college student and football player who sustained a compound fracture of his right tibia and fibula. While awaiting surgery he became short of breasth, tachpneic and tachycardic and his saturations dropped to 70’s from 90’s on room air. He had a fever to 103, heart rate of 100, respiratory rate of 30, and a systolic pressure of 140. He required intubation for 5 days but did recover thereafter. 
code lung bone fracture fat embolus respiratory distress Courtesy Ashley Davidoff MD copyright 2009 all rights reserved 86255c.8s



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code lung bone fracture fat embolus respiratory distress Courtesy Ashley Davidoff MD copyright 2009 all rights reserved 86255c.8s
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PE from Upper Limb Thrombosis



This elderly woman presented with acute respiratory difficulty with swelling of her left upper limb. CT shows extensive pulmonary embolic disease to the lower lobes from second order branches to the tertiary branches (1-4 with green overlay) and evidence of thrombosis of the left subclavian vein. (5,6). Swelling over the anterior chest including the pectoralis muscles is evident in 7. Courtesy Priscilla Slanetz MD. 32538cLW



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PE from Upper Limb Thrombosis



This elderly woman presented with acute respiratory difficulty with swelling of her left upper limb. CT shows extensive pulmonary embolic disease to the lower lobes from second order branches to the tertiary branches (1-4 with green overlay) and evidence of thrombosis of the left subclavian vein. (5,6). Swelling over the anterior chest including the pectoralis muscles is evident in 7. Courtesy Priscilla Slanetz MD. 32538cLW



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PE from Upper Limb Thrombosis

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Pulmonary Emboli Before and After Treatment



The patient has breast carcinoma and was shown in the set of images above.  She presented with shortness of breath and pulmonary emboli were diagnosed as filling defects (overlay in royal blue c), in all the visualized vessels.  After 2 weeks of anticiacougulant therapy the emboli were lysed and the vessels were completely patent (overlaid in red in d)
78540c02s elderly lady wih breast carcinoma presents with SOB lung artery filling defects pulmonary emboli 2 weeks following treatment emboli resolved Courtesy Ashley Davidoff MD copyright 2008



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Pulmonary Emboli Before and After Treatment



The patient has breast carcinoma and was shown in the set of images above.  She presented with shortness of breath and pulmonary emboli were diagnosed as filling defects (overlay in royal blue c), in all the visualized vessels.  After 2 weeks of anticiacougulant therapy the emboli were lysed and the vessels were completely patent (overlaid in red in d)
78540c02s elderly lady wih breast carcinoma presents with SOB lung artery filling defects pulmonary emboli 2 weeks following treatment emboli resolved Courtesy Ashley Davidoff MD copyright 2008



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78540c02s elderly lady wih breast carcinoma presents with SOB lung artery filling defects pulmonary emboli 2 weeks following treatment emboli resolved Courtesy Ashley Davidoff MD copyright 2008
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78540c02s elderly lady wih breast carcinoma presents with SOB lung artery filling defects pulmonary emboli 2 weeks following treatment emboli resolved Courtesy Ashley Davidoff MD copyright 2008
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Breast Carcinoma and Pulmonary Emboli



This CT is from an elderly lady wih breast carcinoma, who presents with SOB .  Noted are filling defects in the pulmonary arteries (white arrow). The left sided pulmonary arteries also have filling defects. (see next set of images) She has had a left mastectomy, (green arrow) and has lytic metastases of the left ribs with destruction of the bone which remain as two white calcific specks (teal blue arrow). A small pleural effusion on the left may be due to the malignancy (likely) or due to the pulmonary embolus.
lung artery filling defects pulmonary emboli 2 weeks following treatment emboli resolved Courtesy Ashley Davidoff MD copyright 2008 78540c03.8s



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Breast Carcinoma and Pulmonary Emboli



This CT is from an elderly lady wih breast carcinoma, who presents with SOB .  Noted are filling defects in the pulmonary arteries (white arrow). The left sided pulmonary arteries also have filling defects. (see next set of images) She has had a left mastectomy, (green arrow) and has lytic metastases of the left ribs with destruction of the bone which remain as two white calcific specks (teal blue arrow). A small pleural effusion on the left may be due to the malignancy (likely) or due to the pulmonary embolus.
lung artery filling defects pulmonary emboli 2 weeks following treatment emboli resolved Courtesy Ashley Davidoff MD copyright 2008 78540c03.8s



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lung artery filling defects pulmonary emboli 2 weeks following treatment emboli resolved Courtesy Ashley Davidoff MD copyright 2008 78540c03.8s
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lung artery filling defects pulmonary emboli 2 weeks following treatment emboli resolved Courtesy Ashley Davidoff MD copyright 2008 78540c03.8s
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Wedge Shaped Infarct in the Spleen



The CTscan with contrast shows a wedge shaped defect in the spleen (overlaid in pink in middle image) characteristic of an acute infarction most commonly caused by emboli.  The pathology image from a different patient shows the same wedge shaped process.
46774c01 21321spleen splenic fx wedge shaped defects dx emboli dx systemic embolization dx splenic infarcts CTscan Davidoff MD



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Wedge Shaped Infarct in the Spleen



The CTscan with contrast shows a wedge shaped defect in the spleen (overlaid in pink in middle image) characteristic of an acute infarction most commonly caused by emboli.  The pathology image from a different patient shows the same wedge shaped process.
46774c01 21321spleen splenic fx wedge shaped defects dx emboli dx systemic embolization dx splenic infarcts CTscan Davidoff MD



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46774c01 21321spleen splenic fx wedge shaped defects dx emboli dx systemic embolization dx splenic infarcts CTscan Davidoff MD
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46774c01 21321spleen splenic fx wedge shaped defects dx emboli dx systemic embolization dx splenic infarcts CTscan Davidoff MD
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Embolic Infarct of the Splenic Artery


47640 spleen artery fx wedge shaped defect fx occluded artery dx embolism embolic infarction CTscan Davidoff MD



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Embolic Infarct of the Splenic Artery


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Emboli to the Posterior Circulation Involving the Cerbellum and the Occipital Cortex



74923c01 brain emboli low density lesions posterior cerebral circulation cerebellum occipital lobe occipital infarcts cerebellar infarcts embolic disease CTscan Courtesy Ashley DAvidoff MD



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Emboli to the Posterior Circulation Involving the Cerbellum and the Occipital Cortex



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Cerebellar and Parietal Lobe Involvement



71239c04 patient with atrial fibrillation brain cerebrum cerebelum cerebellar hemisphere multicentric parietal lobe parasagittal hemorrhagic infarct paracentral DWII bright T2 bright FLAIR bright GRE mixed blood products dx acute hemorrhagic infarction secondary to embolic event the patient disd have other non hemorrhagic infrctions in other parts of the brain MRI Davidoff MD 71239c0171239c02 71239c03 71239c04



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71239c04 patient with atrial fibrillation brain cerebrum cerebelum cerebellar hemisphere multicentric parietal lobe parasagittal hemorrhagic infarct paracentral DWII bright T2 bright FLAIR bright GRE mixed blood products dx acute hemorrhagic infarction secondary to embolic event the patient disd have other non hemorrhagic infrctions in other parts of the brain MRI Davidoff MD 71239c0171239c02 71239c03 71239c04



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The Common Vein

TCV