CTICasesNon-Resolution of Acute Pulmonary Embolism (Chronic Thromboembolic Occlusion)
Imaging findings
An older patient experienced a significant acute pulmonary embolism, with substantial clot burden particularly in the left lower lobe pulmonary artery. Follow-up imaging several months later demonstrated complete resolution of most pulmonary emboli, but the left lower lobe pulmonary artery and the right middle lobe pulmonary artery remained completely occluded by fibrothrombotic material. Imaging also showed small shadows suggestive of infarcted lung tissue and a new cystic space. Pulmonary blood volume maps confirmed absent perfusion in these occluded regions.
Key takeaways
Not all acute pulmonary emboli resolve completely. A significant proportion can lead to chronic thromboembolic disease, characterized by persistent, non-resolving fibrothrombotic occlusion of pulmonary arteries. This phenomenon can result in impaired lung perfusion and, in some cases, lead to pulmonary infarction and the formation of cystic changes in the affected lung parenchyma.
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