Emergency Radiology

, Volume 26, Issue 6, pp 623–630 | Cite as

Septal bowing and pulmonary artery diameter on computed tomography pulmonary angiography are associated with short-term outcomes in patients with acute pulmonary embolism

  • Mads Dam Lyhne
  • Jacob Gammelgaard Schultz
  • Peter J. MacMahon
  • Faris Haddad
  • Mannudeep Kalra
  • David Mai-King Tso
  • Alona Muzikansky
  • Michael H Lev
  • Christopher KabrhelEmail author
Original Article



Patients with acute pulmonary embolism (PE) can quickly deteriorate and the condition has high mortality due to right ventricular (RV) failure. Immediately available predictors of adverse outcome are of major interest to the treating physician in the acute setting. The purpose of the present study was to evaluate if easily attainable measurements of RV function from the diagnostic computed tomography pulmonary angiography (CTPA) provide information for fast risk stratification in patients with acute PE.


We retrospectively evaluated images from CTPA in 261 patients (age median 60 years, 50% females) enrolled in a prospective study. RV and left ventricular (LV) diameters and their ratio, the presence of septal bowing, contrast reflux in the inferior vena cava, and the diameter of the central pulmonary arteries (PA) were measured. The composite outcome was 5-day severe adverse events including death, acute decompensation, or need for emergent treatment. We used Wilcoxon rank sum test and Fischer’s exact test to test between groups and multivariate logistic regression for prediction.


In multivariate analysis, increased diameter of the main PA (OR = 1.08 per 1 mm increase, p = 0.047) and the presence of septal bowing (OR = 2.23, p = 0.055) were associated with severe adverse events. RV/LV > 1 did not predict severe outcomes (OR = 0.73, p = 0.541).


Two easily attainable parameters of RV function on CTPA, septal bowing and main PA diameter, are associated with short-term adverse outcomes in patients with acute PE. Further study is required to determine whether these findings can be incorporated into clinical treatment algorithms.


Acute pulmonary embolism Computed tomography Right ventricular function Predictors Emergency care 



No funding was received for the present analysis, but the original prospective study was funded by Harvard Milton Fund.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© American Society of Emergency Radiology 2019
corrected publication 2019

Authors and Affiliations

  • Mads Dam Lyhne
    • 1
    • 2
  • Jacob Gammelgaard Schultz
    • 1
    • 2
  • Peter J. MacMahon
    • 3
  • Faris Haddad
    • 4
  • Mannudeep Kalra
    • 5
  • David Mai-King Tso
    • 5
  • Alona Muzikansky
    • 6
  • Michael H Lev
    • 5
  • Christopher Kabrhel
    • 1
    Email author
  1. 1.Center for Vascular Emergencies, Department of Emergency MedicineMassachusetts General HospitalBostonUSA
  2. 2.Department of CardiologyAarhus University HospitalAarhusDenmark
  3. 3.Department of RadiologyMater Misericordiae University HospitalDublinIreland
  4. 4.Department of RadiologyInova Fairfax HospitalFalls ChurchUSA
  5. 5.Department of RadiologyMassachusetts General HospitalBostonUSA
  6. 6.Biostatistics CenterMassachusetts General HospitalBostonUSA

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