CTICasesAcute Pulmonary Embolism with Hyperattenuating Clots on Non-Contrast CT
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Imaging findings
Non-contrast CT, performed as part of an acute aortic syndrome protocol for chest pain, reveals no acute intramural hematoma. However, subtle abnormal hyperattenuation is visible within the pulmonary arteries, particularly in the main pulmonary artery and its branches. Subsequent contrast-enhanced CT confirms these hyperattenuating areas as acute pulmonary emboli (clots).
Key takeaways
Acute pulmonary emboli can occasionally be detected on non-contrast CT due to their hyperattenuating appearance (the "hyperdense clot sign"). While not a primary diagnostic tool for PE, radiologists should be vigilant for this subtle sign, especially when evaluating non-contrast studies for other indications in patients with chest pain. This highlights the importance of scrutinizing all images in a multiphase study.
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