Korean J Radiol.  2013 Oct;14(5):854-858. 10.3348/kjr.2013.14.5.854.

Visualization of Peripheral Pulmonary Artery Red Thrombi Utilizing Optical Coherence Tomography

• Hong C
• Wang W
• Zhong NS
• Zeng GQ
• Zhang NF

• KMID: 1711447
• DOI: http://doi.org/10.3348/kjr.2013.14.5.854

Abstract

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.

Keyword

Optical coherence tomography; Peripheral pulmonary artery thrombi; Pulmonary thromboembolism; CT pulmonary angiography; Intravascular ultrasound

MeSH Terms

Adult
Angiography
Humans
Male
Pulmonary Artery/*pathology/radiography
Pulmonary Embolism/*diagnosis
Tomography, Optical Coherence/*methods
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Computed tomography pulmonary angigraphy images before and after thrombolytic and anticoagulation therapy (A-D), and detection of peripheral arterial thrombi at the right lower lung (E-H), and OCT images and pathological study of the thrombus (I-L). Cross-section and coronal multiplanar reconstruction multi-detection computed tomography pulmonary angiography images of chest. (A) and (C) demonstrate multiple filling defects (black arrows) in left and right pulmonary arteries and enlargement of main pulmonary before treatment. (B) shows no clots in central pulmonary arteries, but shows inconclusive filling defect in peripheral pulmonary artery of right lower lobe, which is shown in (D) (white arrow), after thrombolysis and subsequent anticoagulation therapy. Correlation between coronal multi-detection computed tomography pulmonary angiography (MDCTA) image, pulmonary artery (PA) angiogram and selective pulmonary artery (SPA) angiogram. (E) shows post-treatment check MDCTA image, inconclusive filling defect in peripheral PA of right lower lobe is demonstrated with white arrow and matches with filling defect sign with black arrow is shown in (F) in PA angiogram and (G) in SPA angiogram, respectively. (H) shows same peripheral PA, which is recanalized after thrombus aspiration. Correlation between selective pulmonary segmental artery angiograms and optical coherence tomography (OCT) cross-sectional and longitudinal images at baseline and after thrombus aspiration. Basal angiogram (I) shows nearly total occlusion of lateral-basal segment of right lower lobe in contrast to corresponding OCT cross-sectional images (a, b, and c) and longitudinal view (d). OCT cross-sectional image (a) shows side branch (SB) that is used as landmark to locate corresponding sites between angiogram and OCT images. Images (b and c) show massive protruding into lumen (arrow). Image (d) shows lumen is obstructive and sites corresponding to images (a, b, and c) are identified by white lines, respectively. After thrombus aspiration, image (J) shows that no filling defect is observed and artery lumen is unobstructed; these corresponding sites OCT images are shown in right lower panel. OCT cross-sectional image (e, f, and g) and longitudinal view (h) corresponds to images (a, b, c, and d), respectively. OCT cross-sectional image (e) shows SB and images (f, g, and h) clearly demonstrate disappearance of protrusions and enlarged lumen, compared with images (b, c, and d), respectively. Corresponding sites to images (e, f, and g) are marked in image (h) with white lines, respectively. Gross appearance and histologic examination of retrieved materials from catheter. (K) shows that these retrieved materials appear as dark-red strip-like structure (scale bar 3 mm). Histologic examination in (L) shows that these materials primarily consist of red blood cells (arrow).

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