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

  • Computed Tomography
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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.

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Conflict of interest

None of the authors has any conflict of interest to declare.

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Authors and Affiliations

  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, David Attias, Julie Guiader, Imad Abi Nasr & Olivier Dubourg

  2. Intensive Care Unit, Université de Versailles-Saint Quentin (UVSQ), Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne, France

    Vincent Caille, François Jardin & Antoine Vieillard-Baron

  3. Department of Radiology, Université de Versailles-Saint Quentin (UVSQ), Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne, France

    Julien Desperramons, Mostafa El Hajjam & Pascal Lacombe

  4. AP-HP, Hôpital Universitaire Ambroise Paré, Service de Cardiologie et des Maladies Vasculaires, Centre de Référence des Maladies Cardiaques Héréditaires, 9 avenue Charles de Gaulle, 92100, Boulogne, France

    Nicolas Mansencal

Authors
  1. Nicolas Mansencal
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  2. David Attias
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  3. Vincent Caille
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  4. Julien Desperramons
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  5. Julie Guiader
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  6. Mostafa El Hajjam
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  7. Pascal Lacombe
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  8. Imad Abi Nasr
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  9. François Jardin
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  10. Antoine Vieillard-Baron
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  11. Olivier Dubourg
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Corresponding author

Correspondence to Nicolas Mansencal.

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Mansencal, N., Attias, D., Caille, V. et al. Computed tomography for the detection of free-floating thrombi in the right heart in acute pulmonary embolism. Eur Radiol 21, 240–245 (2011). https://doi.org/10.1007/s00330-010-1942-0

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  • DOI: https://doi.org/10.1007/s00330-010-1942-0

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