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Eur Radiol. 2011 Feb;21(2):240-5. doi: 10.1007/s00330-010-1942-0. Epub 2010 Aug 31.

Computed tomography for the detection of free-floating thrombi in the right heart in acute pulmonary embolism.

Author information

1
Department of Cardiology, Université de Versailles-Saint Quentin (UVSQ), Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Référence des Maladies Cardiaques Héréditaires, Boulogne, France. nicolas.mansencal@apr.aphp.fr

Abstract

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).

CONCLUSION:

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.

PMID:
20809126
DOI:
10.1007/s00330-010-1942-0
[Indexed for MEDLINE]

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