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|Number 09-19: Pulmonary Embolism by CMR|
Number 09-19: Pulmonary Embolism by CMR
Case from: Andrei Samarin, MD1, 2, Roger Shifrin, MD2, Carsten Schmalfuss MD2, Gary Cooper MD2
Clinical history: A 34-year-old white female with a history of anxiety, mild asthma, and allergic rhinitis was recently hospitalized with an episode of SVT. She was not taking any medications, except for oral contraceptives.
The initial axial (Image 1) and coronal (Image 2) SSFP localizer aised the suspicion of a saddle embolus (white arrow) at the RPA/LPA bifurcation.
Movie 1 Movie 2
Chest CT: axial contrast enhanced images (Image 3) demonstrated the saddle embolus (black arrow) and confirmed the diagnosis.
A coagulopathy was then excluded and the only causative factor for embolism seemed to be oral contraceptives.
Perspective: In patients with otherwise unexplained elevation of right heart pressures undergoing CMR, the pulmonary arteries should be carefully examined for evidence of emboli. In this setting, CMR bright blood imaging is a useful technique to assess the main PA, and the origin and proximal segments of the RPA and LPA. However, only contrast enhanced MRA can image the full pulmonary tree, including the distal branches.
2. Altun E, Heredia V, Pamuklar E, Zapparoli M, Semelka RC. Feasibility of post-gadolinium three-dimensional gradient-echo sequence to evaluate the pulmonary arterial vasculature. Magn Reson Imaging 2009;27:1198-207.
3. Miserus RJ, Herias MV, Prinzen L, Lobbes MB, Van Suylen RJ, Dirksen A, Hackeng TM, Heemskerk JW, van Engelshoven JM, Daemen MJ, van Zandvoort MA, Heeneman S, Kooi ME. Molecular MRI of early thrombus formation using a bimodal alpha2-antiplasmin-based contrast agent. JACC Cardiovasc Imaging 2009;2:987-96.
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