Computed Tomography for the Detection of Free-Floating Thrombi in the Right Heart in Acute Pulmonary Embolism

OBJECTIVES: The aim of this study was to assess the prevalence of free-floating thrombi in the right heart (FFT) and the accuracy of computed tomography (CT) for their detection in pulmonary embolism (PE).

METHODS: We studied 340 consecutive patients presenting with PE. All patients underwent CT and echocardiography.

RESULTS: The prevalence of FFT was 3.5% in the global population of PE and 22% in high-risk PE. Dyspnoea, cardiogenic shock, cardiac arrest and tachycardia were more frequently found in patients with FFT (p = 0.04, p < 0.0001, p = 0.0003 and p = 0.01, respectively). Sensitivity and specificity of CT for the detection of FFT were 100% (95% confidence interval: 74%-100%) and 97% (95%-99%), whereas positive and negative predictive values were 57% (34%-78%) and 100% (99%-100%). Among patients with FFT, right ventricular dilation was always detected by CT, whereas no right ventricular dilation was found among patients with a false diagnosis of FFT performed by CT (p < 0.0001).

CONCLUSIONS: Prevalence of FFT is 3.5% and differs according to the clinical presentation. Detection of FFT by CT is feasible and should lead to echocardiography being promptly performed for the confirmation of FFT. Jordan Evans Womens Jersey

PMID: 20809126

Posted in Computed Tomography and tagged , , , , , .

One Comment

  1. I have to admit hat I have never seen a case of free floating right-sided thrombi… and I look for them!

    The reported prevalence from previous estimates ranges from 3.6% to 18%, and in this specific paper is at 3.5%. This seems a bit high.

    In my experience, since the ROI for triggering is placed at the MPA, there is still a fair amount of mixing of dense contrast in the RA and that usually makes assessing that region a bit more difficult. The authors mention this as well and do measure the PPV of CT at only 57%.

    Interesting concept and potentially useful information as FFT seem to be associated with a worse prognosis.

Leave a Reply

Your email address will not be published. Required fields are marked *