Detection of peripheral embolic consolidations using contrast-enhanced ultrasonography in patients with no evidence of pulmonary embolism on computed tomography: A pilot study

Journal of Clinical UltrasoundTrenker C, et al. | July 26, 2017

This research aimed to examine the value of B–mode imaging and contrast–enhanced ultrasonography (CEUS) in patients with clinically suspected pulmonary embolism (PE) but no evidence of central PE on CT. In spite of the absence of definite confirmation of peripheral and central PE on CT, peripheral pleural consolidations with no or inhomogeneous enhancement on CEUS, in combination with the risk profile for a PE, were highly suggestive of embolic consolidations (EC). The authors suggested that CEUS might close a potential diagnostic gap of small peripheral PE on CT.

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Methods

  • Between May 2004 and February 2015, nineteen patients were included with a risk profile for PE according to their Wells' score, sonographic patterns of peripheral embolic consolidations (EC) on B-mode-imaging and CEUS (ie, missing or inhomogeneous enhancement of the pleural lesions), and exclusion of central PE by CT within one week of CEUS.

Results

  • Nineteen pleural defects presented as hypoechoic on B-mode imaging.
  • It was observed in the findings that the shape of EC was round in two, wedge-shaped in twelve, polygonal in three, and presented as atelectasis in two cases.
  • On CEUS, five of the defects demonstrated, at the arterial and parenchymal phase, a lack of enhancement, and fourteen demonstrated an inhomogeneous (mixed) enhancement with wedge-shaped peripheral areas of no contrast enhancement.
  • A second radiologic evaluation of the CT scans identified PE in 2 patients and lesions suspicious for malignancy in 2 other patients.

Read the full article on Journal of Clinical Ultrasound

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