This study was done to demonstrate the computed tomography (CT) and pathologic findings of the sequential changes for experimental pulmonary fat embolism (PFE), and to correlate the CT and pathologic findings of rabbit lung. PFE was induced by an intravenous injection of 0.2 mL linoleic acid in 24 rabbits. The rabbits were divided into 4 groups of 6 rabbits each. CT scans were obtained sequentially at 2 hr (n= 24), day 1 (n=18), day 3 (n=12) and day 7 (n=6) after fat embolization. The pathologic findings were analyzed and CT-pathologic correlation was done. CT scans showed bilateral ground-glass opacity (GGO), consolidation and nodule in all cases. The findings of PFE at 2 hr after fat embolization were areas of decreased attenuation, GGO, consolidation and nodule. These findings were aggravated on the follow- up CT after 1 day and 3 days. The follow-up CT revealed linear density in the subpleural lungs after 7 days. On CT-pathology correlation, wedge-shaped ischemic necrosis in the subpleural lungs correlated with nodule at 2 hr. GGO and consolidation at day 1 on CT correlated with congestion and edema, and these findings at day 3 were correlated with inflammation and hemorrhagic edema. The linear density in the subpleural lungs correlated with interstitial fibrosis and pleural contraction at day 7. In conclusion, PFE was caused by using linoleic acid which is kind of free fatty acid and this study served as one model of the occurrence of nontraumatic PFE. CT accurately depicted the natural evolution of PFE in the serial followup, and this correlated well with the pathologic findings.
Animals ; Embolism, Fat/*pathology/*radiography ; Pulmonary Embolism/*pathology/*radiography ; Rabbits ; *Tomography, X-Ray Computed

We present a case with rare complication of percutaneous vertebroplasty with polymethylmethacrylate (PMMA). A pulmonary embolus was detected in a 79-year-old woman with osteoporotic compression fracture after percutaneous verteroplasty. Chest radiography, computed tomography, and ventilation perfusion lung scan con-firmed pulmonary infarction and the presence of PMMA in the pulmonary arteries. She was treated with anticoagulants and responded favorably. Although venous leakage of PMMA has shown to be not uncommon, only a few cases of symptomatic pulmonary embolism have been reported. Adequate preparation of PMMA, optimal injection technique, and confirmation with biplane fluoroscopy are mandatory to minimize this type of complication.
Aged ; Anticoagulants ; Embolism ; Female ; Fluoroscopy ; Fractures, Compression ; Humans ; Lung ; Perfusion ; Polymethyl Methacrylate* ; Pulmonary Artery ; Pulmonary Embolism* ; Pulmonary Infarction ; Radiography ; Thorax ; Ventilation ; Vertebroplasty*

OBJECTIVE: We wanted to prospectively evaluate the interobserver agreement between radiology residents and expert radiologists for interpreting CT images for making the diagnosis of pulmonary embolism (PE). MATERIALS AND METHODS: We assessed 112 consecutive patients, from April 2007 to August 2007, who were referred for combined CT pulmonary angiography and indirect CT venography for clinically suspected acute PE. CT scanning was performed with a 64x0.5 collimation multi-detector CT scanner. The CT studies were initially interpreted by the radiology residents alone and then the CT images were subsequently interpreted by a consensus of the resident plus an experienced general radiologist and an experienced chest radiologist. RESULTS: Two of the 112 CTs were unable to be interpreted (1.7%). Pulmonary artery clots were seen on 36 of the thoracic CT angiographies (32%). The interobserver agreement between the radiology residents and the consensus interpretation was good (a kappa index of 0.73). All of the disagreements (15 cases) were instances of overcall by the resident on the initial interpretation. Deep venous thrombosis was detected in 72% (26 of 36) of the patients who had PE seen on thoracic CT. The initial and consensus interpretations of the CT venography images disagreed for two cases (kappa statistic: 0.96). CONCLUSION: It does not seem adequate to base the final long-term treatment of PE on only the resident's reading, as false positives occurred in 13% of such cases. Timely interpretation of the CT pulmonary angiography and CT venography images should be performed by experienced radiologists for the patients with suspected PE.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Observer Variation ; *Phlebography ; Pulmonary Artery/*radiography ; Pulmonary Embolism/*radiography ; *Tomography, X-Ray Computed ; Venous Thrombosis/*radiography ; Young Adult

A pulmonary embolism is a rare, but well described complication of percutaneous vertebroplasty; the majority of cases are caused by acrylic cement. Here, for the first time, we report a case of pulmonary embolism due to a thrombus in the right atrium, which was caused by an acrylic cement foreign body in the right atrium and central veins 6 years after percutaneous vertebroplasty. This case suggests that an acrylic cement foreign body should be considered as a potential source of thrombus formation in patients that develop a pulmonary embolism following percutaneous vertebroplasty.
Foreign Bodies* ; Heart Atria* ; Humans ; Pulmonary Embolism* ; Radiography, Interventional ; Thrombosis* ; Veins ; Vertebroplasty*

Percutaneous vertebroplasty is an effective, minimally invasive procedure for the treatment of vertebral compression fractures, and is a technique for treating lower back pain that appears to be increasingly popular throughout the world. We experienced two cases involving a rare complication of percutaneous vertebroplasty, namely pulmonary embolism caused by acrylic cement. One patient showed no subjective symptoms after vertebroplasty, while the other experienced chest pain. In the former, fluoroscopy demonstrated perivertebral venous leakage during vertebroplasty, and at chest radiography, tubular or branching high-density linear structures were observed. In addition, intravascular emboli were identified at CT. In the second patient, symptomatic therapy led to reduced chest pain.
Chest Pain ; Fluoroscopy ; Fractures, Compression ; Humans ; Low Back Pain ; Pulmonary Embolism* ; Radiography ; Thorax ; Vertebroplasty*

PURPOSE: Since 1995, we have reconstructed defects of the proximal femoral bone with the autogenous unicortical iliac bone by revision hip arthroplasty. We report the preliminary results of this method. MATERIALS AND METHODS: Among cases of revision hip arthroplasty reconstructed with autogenous unicortical iliac bone graft between March 1995 and December 1997, we studied 45 cases, which had been followed for more than 2 years. The loss of femoral bone was classified using AAOS classification. Twenty four cases belonged to level 1, segmental type and 21 cases belonged to level 1, segmental with level 2 cavitary type. We documented the healing process of grafted bone by simple radiography every 6 months and evaluated clinical results by Harris scoring. RESULTS: The average Harris score improved from 67.2 to 79.5. Radiological union was found at an average 4.5 months, and complete union at an average 19 months. There were 2 cases of loosening, 4 prolonged pain on the bone-harvested site, 3 trochanteric nonunion, one sciatic nerve palsy and one pulmonary embolism. CONCLUSION: Small sized defects of the proximal femur are reconstructed satisfactorily by using autogenous unicortical iliac bone graft in revision hip arthroplasty.
Arthroplasty* ; Bone Plates* ; Classification ; Femur ; Hip* ; Pulmonary Embolism ; Radiography ; Sciatic Neuropathy ; Transplants

Optical coherence tomography (OCT) is a new imaging technique capable of obtaining high-resolution intravascular images and has been used in interventional cardiology. However, an application of OCT in pulmonary arteries had seldom been documented. In this case, OCT imaging is performed in peripheral pulmonary arteries and shows mural red thrombi. Subsequently, the red thrombi are aspirated and confirmed by a histological examination. These findings suggest that OCT may be a useful tool to depict peripheral pulmonary artery thrombi.
Adult ; Angiography ; Humans ; Male ; Pulmonary Artery/*pathology/radiography ; Pulmonary Embolism/*diagnosis ; Tomography, Optical Coherence/*methods ; Tomography, X-Ray Computed

Unilateral absence of a pulmonary artery is an uncommon anomaly, which presents as an isolated lesion or in combination with other congenital heart disease such as TOF or PD^. We encountered three cases of isolated unilateral absence of a pulmonary artery;one was left pulmonary artery agenesis with right sided aortic arch and the others were right pulmonary artery agenesis with left sided aortic arch. Plain chest radiograph showed considerable loss of unilateal lung volume and lack of ipsilateral hilar shadow. Pulmonary angiogram which was done in two cases, revealed proximal interruption of a pulmonary artery. Chest CT was done in only one case, on which right pulmonary artery was absent and was replaced by adipose tissue. CT with its clean demonstration pulmonary artery without any evidence of aquired obstruction of a pulmonary artery by pulmonary embolism or tumor invasion, maybe a valuable method for evaluaton of the unilateral absence of a pulmonary artery.
Adipose Tissue ; Aorta, Thoracic ; Heart Defects, Congenital ; Lung ; Pulmonary Artery* ; Pulmonary Embolism ; Radiography, Thoracic ; Tomography, X-Ray Computed

PURPOSE: To evaluate the low attenuation of mosaic pattern in pulmonary embolism, as observed on HRCT, and to correlate the findings with the pathologic features of resected lung. MATERIALS AND METHODS: Using permanent embolic materials, pulmonary embolism was induced in eight Yorkshire pigs. Pre-and post-embolic pulmonary angiography was performed and after 6 weeks, the incidence and pattern of parenchymal change in low attenuation (mosaic pattern), as seen on HRCT, was evaluated. The animals were then sacrified and contact radiography of the lung was performed. Thirty-eight segments of pathology were taken from the area in which the presence of embolism had been suggested. Pathologic and HRCT findings were then correlated. RESULTS: On HRCT, low attenuation was seen in 23 of 36 segments (64%) and showed variable patterns : crescent peripheral hyperlucency (61%, n=14), heterogeneous mottled hyperlucency (17%, n=4), lobular hyperlucency (13%, n=3), and homogeneous segmental hyperlucency (9%, n=2). Parenchymal low attenuation was seen on HRCT in 10 of 11 segments (91%) in which large segmental arterial occlusion occurred, and in 3 of 16 segments (19%) in which there was small segmental arterial occlusion. Abnormal pathologic findings were pulmonary congestion, dilatation of pulmonary arteries, interlobular septal thickening, and thrombus formation. Among the 38 pathologic segmental specimens, 29 were from the area in which HRCT findings were positive, and in which pulmonary embolism subsequently occurred. In only four of nine segments (44%) in the area in which HRCT fingings were negative was pulmonary embolism subsequently. CONCLUSION: HRCT findings of pulmonary embolism at six weeks after embolization showed variable patterns of low attenuation, diminished diameter of pulmonary arteries, and normal diameter of bronchi. In cases with large segmental arterial occlusion, the finding of low attenuation was more common ; this may be due to reduced blood flow to the embolic area, in combination with bronchiolar spasm. For the early diagnosis of pulmonary embolism, these findings may be useful.
Angiography ; Animals ; Bronchi ; Dilatation ; Early Diagnosis ; Embolism ; Estrogens, Conjugated (USP) ; Incidence ; Lung ; Pathology ; Pulmonary Artery ; Pulmonary Embolism* ; Radiography ; Spasm ; Swine ; Thrombosis

Laparoscopy is a surgical procedure used both for diagnosis and for various treatments. A rare but sometimes fatal complication of laparoscopy is pulmonary embolism with CO2 resulting in pulmonary edema. During laparoscopic gynecological surgery in a 29-year-old woman who had previously undergone lower abdominal surgery, the end-tidal CO2 suddenly increased from 40mmHg to 85mmHg and then decreased to 13mmHg with hemodynamic deterioration. These events are characteristic of a CO2 embolism. When this occurred, CO2 insufflation was immediately stopped and the patient was resuscitated. The patient's condition gradually improved with aggressive treatment, but the clinical course was complicated by bilateral pulmonary edema. This case of pulmonary edema was soon resolved with supportive management. The formation of a CO2 embolism during laparoscopy must be suspected whenever there is a sudden change in the end-tidal CO2. In addition, the possibility of pulmonary edema should be considered when a CO2 embolism occurs.
Adult ; Carbon Dioxide/*metabolism ; *Cystectomy ; Female ; Humans ; *Laparoscopy ; Ovarian Cysts/*surgery ; Pulmonary Edema/*complications/metabolism/radiography ; Pulmonary Embolism/*complications/metabolism/radiography