CTICasesAtypical Pulmonary Embolism with Low Contrast Bolus
Imaging findings
Initial chest CT was read as negative for PE but had poor contrast enhancement (bolus under 100 HU). Follow-up CT abdomen/pelvis next day clearly demonstrates a large pulmonary embolism in the right middle lobe branch.
Key takeaways
A poorly-enhanced chest CT (due to low contrast volume, timing, or transient interruption of contrast) is a major diagnostic pitfall that can lead to false-negative PE interpretations. Even with monoenergetic dual-energy CT reconstruction, a suboptimal bolus can mask a pulmonary embolism.
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