CT signs of right heart strain with PE

This video goes over the CT signs of right heart strain that can be seen with acute pulmonary embolism. I describe and show examples of RV enlargement, septal bowing/flattening, pulmonary artery enlargement, and reflux of contrast into the IVC.

[@robertreddy9769]

You may want to mention in future lectures that mentioning findings of right heart strain are extremely useful in stratifying these patients for interventional therapies. At our institution we have a Pulmonary Embolism Response Team (PERT) which won't alert the interventional radiologists unless these criteria are met and/or mentioned for possible mechanical thrombectomy (Pneumbra or Inari extraction) or placement of infusion catheter (EKOS). Nice talk.

[@ThoracicRadiology]

Good point! Thanks for your input.

[@howdareu964]

the mentioning of right heart strain being present on positive PE studies is encouraged. which goes to your point eluding to the necessity of emergent intervention ie pulmonary thrombectomy

[@howdareu964]

the mentioning of right heart strain being present on positive PE studies is encouraged. which goes to your point eluding to the necessity of emergent intervention ie pulmonary thrombectomy

[@richardgower2605]

Very useful thank you. If only Echocardiogram interpretation was explained this well !

[@ahmadsindi8407]

Thank you. Very useful and very nice way in explnation

[@minhtantran2885]

Learnt a lot from your presentation Sir! Realistic example and clearly explanation, keep up your amazing work.

[@kimbowen8097]

great lecture thank you so much, it seems to me everything is clear ... i've been working ER internist even though my major is Family medicine. anyway thx

[@marmaladebrah]

Great video, thank you!

[@miavs12345diva]

Many thanks, Dr. Rishi 🙏

[@user-yl7vl7kg7x]

Excellent... thank u

[@ghostr759]

excellent,,,,,can u please discuss more on lung findings with more heart diseases

[@poojanarwani8821]

Thanks for the excellent video. If you could please make video on what lung nodules to follow ? How to differentiate between inflammatory vs malignant looking nodule? Thank you

[@ThoracicRadiology]

Great suggestion! This topic is on my list.

[@scottm4267]

Thank you

[@debbiedilts6294]

I recently had a right PE and was noted to have a 1.12 right heart strain. Is therd any further tesing needed .

[@kaushikn2038]

We need more videos. Finished all the ones on youtube

[@ThoracicRadiology]

Many thanks! I am working on some new content...

[@kaushikn2038]

@@ThoracicRadiology yay..!!!

[@vishnuchandrus6596]

Thank you sir

[@dilipmundhada5875]

Very good excellently presented teaching video. Learnt new things in CT. Shall you report all these quantitative observations when reporting CTPA done for PE?. Does it help to prognosticate in clinical setting?

[@ThoracicRadiology]

Great questions. I don't report all of these unless they are abnormal. I think in the end, the clinical signs are more valuable for prognosis compared to the radiologic signs.

[@MissBambamable]

Even when watching the topic I am fairly familiar with, I always learn something new from your videos... Like why it is better to do the measurements on the same slice... Thank you so much for the fantastic explanations! P.S. Is there a pulmonary infarct on the right in the second PE case, at 8:35?

[@ThoracicRadiology]

Yes you’re right, that is an infarct. Good eye!

[@moclack4058]

Thanks a lot, I’d grateful if you could post video explain how to read CTPA please

[@ThoracicRadiology]

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[@moclack4058]

@@ThoracicRadiology thanks so much

[@dr.kapilbabbar5533]

thank you sir very much..

[@ThoracicRadiology]

Most welcome

[@dr.kapilbabbar5533]

@@ThoracicRadiology I am biggest fan of you sir..plz post your mail id .. thanx

[@kimonlee527]

Thanks for your excellent presentation. Here is a quick question, do you will make some comments " acute PE with right heart strain" or something like that on your report?

[@ThoracicRadiology]

Great question, yes I say "acute PE with evidence of right heart strain including x, y, z." Or I say acute PE with no evidence of right heart strain.

[@أحمدعبدالرزاق-ك3ز]

How can we use these signs in a known cardiac patient?

[@baranitharan6381]

Thanks for the lecture! If the heart position is deviated due to fibrotic pathology of lung like tuberculosis, can we still rely on axial sections to measure the ventricles?

[@CelestialTrailblazer]

Can't exercise/workout because of Shortness of breath, Anxiety, GE junction Intestinal Metaplasia, Pulmonary nodules, Heart valve problem (MVP), Abnormal irregular heart rate just from slight movement (ex: sitting in a chair to walking to the bathroom heart rate go from 78bpm- 123bpm or a sneeze causing heart rate to go instantly from 78bpm- 160bpm. Hell even DVT or Blood clots in the lungs might be possibly present as well at this point. The most unfortunate 27 year old alive struggling with all of these health issues for almost a year now.

[@mondashehata5546]

Hi Rishi, this is great presentation. Have a quick question, do you use the term “ right heart strain” only in the setting of submissive PE or do you use it as well if you see the same signs in other causes of severe pulmonary hypertension?

[@ThoracicRadiology]

Hi Monda! Hope you're well. I only use it in the acute PE setting. In the chronic setting, I more use the term signs of pulmonary hypertension or right hear failure or something like that.

[@DamkeDamir]

¸Thank you doctor. It helped me a lot. I appreciate that. You rule.

[@ravindran.murthy6310]

how reliable is it to measure the above three measurements in 16 slice scanner

[@ThoracicRadiology]

Hi, the issue with older scanners is not necessarily the number of slices but the temporal resolution. This has to do with how fast the gantry spins. With slower rotation speed, the less ability of the scanner to freeze motion of the heart. This is made worse by faster heart rates. If you see a lot of motion on your PE studies then this becomes less reliable because of the difficulty in measuring the wall accurately. Thanks for your question.

[@markcamens1866]

What about measuring rv/lv ratio with left ventricular hypertrophy. Well this elevate the ratio even if there isn’t right heart strain?

[@ThoracicRadiology]

good point. Yes, if the LV cavity is very small from LVH then the RV:LV ratio is probably not valid anymore. Thanks for that question.

[@ayyazmahmood4010]

can we label it Right heart starain if a single sign out of 4 you described is present .

[@ThoracicRadiology]

I consider the RV:LV ratio the most important one, and if that is present, I would say there is evidence of right heart strain. The others are not enough on their own in my opinion.

[@CelestialTrailblazer]

The million dollar question: is CT scan without dye contrast can detect blood clots or do you always need CT scan with dye contrast ?

[@ThoracicRadiology]

yes, you need contrast to detect pulmonary embolism

[@CelestialTrailblazer]

@@ThoracicRadiology I see. That could explain why I have shortness of breath for almost a year now and chest pain sometimes. The CT scan I did back in July last year was without contrast and it detected multiple pulmonary nodules and mentioned that I need to re-do the scan without contrast again in 1 year. Perhaps I should do the second one with IV contrast since I can't swallow pills since birth.

[@sharadavinod7074]

Thanks for the video. One quick question. Is it possible for the right hilar node(that is generally present) to be confused with pulmonary artery filling defects? If yes, then how can we differentiate between the two.

[@ThoracicRadiology]

Great question, the answer is yes it is sometimes confused with a filling defect. In an acute PE, it is often easy to tell just by using the coronal and sagittal images. When the PE becomes chronic, it can be very difficult and I usually have to look at the old images as a guide to tell what is what.

[@sharadavinod7074]

@@ThoracicRadiology thank you for your response

[@uniqueflower7043]

Does the heart recover back to normal after PE with right heart strain? Recovering now for a little over a month. I was under the impression the heart recovers after a strain 😢 takes a few months ?

[@ThoracicRadiology]

Yes it can recover

[@jananalrawi1054]

👍🏻 great