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2026, Number 2

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Acta Med 2026; 24 (2)

Incidental pulmonary thromboembolism in a non-contrast CT study: hyperdense lumen sign, intraluminal sign of the hyperdense defect

Motta Ramírez, Gaspar Alberto1,2; Valdés Gómez, Alejandra1,3; Cerda Sánchez, Ana Paola1,4; García Barrios, Grecia Ivonne1,5; Vaca Reyes, María Isabel1,5

Language: English/Spanish [Versión en español]
References: 4
Page: 159-160
PDF size: 729.66 Kb.


ABSTRACT

A 59-year-old male with one day's evolution of dyspnea was requested for a simple phase computed tomography of the chest. After being inconclusive, a thoracoabdominopelvic CT angiography and venography with extension to the lower limbs was requested to specify the clinical diagnostic suspicion of acute pulmonary thromboembolism (PTE), which showed extensive bilateral PTE with areas of hypoperfusion and deep vein thrombosis of the superficial femoral vein and the right popliteal vein.

A reliable criterion for the diagnosis of acute pulmonary embolism (PE) is the visualization of an intraluminal filling defect on a contrast-enhanced computed tomography (CT) scan.1,2

In some cases, a non-contrast CT scan can show dense emboli in the pulmonary artery, the intraluminal hyperdense defect sign. This sign is important because PE can be identified on a non-contrast CT, which helps guide additional imaging for the timely initiation of appropriate therapy (Figure 1).

This sign depends on the difference in the attenuation pattern between the clot and the blood.3 High-density clots in the pulmonary artery exhibited a significantly higher attenuation value, which is likely related to the age of the clot at the time of imaging.

This sign had a sensitivity of 30% and a specificity of 97.6% for detecting acute PE. The sensitivity and specificity of the sign for detecting central PE were 57.1 and 97.6%, respectively, while the percentages for detecting peripheral PE were 8.2 and 97.6%, respectively.3 Therefore, it is a useful indicator of acute PE on non-contrast chest CT, particularly in cases affecting the central pulmonary arteries (Figure 2).4


REFERENCES

  1. Morita S, Ueno E, Masukawa A, Suzuki K, Machida H, Fujimura M. Hyperattenuating signs at unenhanced CT indicating acute vascular disease. Radiographics. 2010; 30 (1): 111-125.

  2. Motta-Ramírez GA. Diagnóstico de tromboembolia pulmonar mediante angiotomografía computada. An Radiol Méx. 2017; 16 (3): 227-250.

  3. Guo R, Deng M, Xi L, Zhang S, Xu W, Liu M. Chest non-contrasted computed tomography in detecting acute pulmonary thromboembolism: a single-center retrospective study. Exp Ther Med. 2024; 28 (2): 304.

  4. Tatco VR, Piedad HH. The validity of hyperdense lumen sign in non-contrast chest CT scans in the detection of pulmonary thromboembolism. Int J Cardiovasc Imaging. 2011; 27 (3): 433-440.



AFFILIATIONS

1 Hospital Angeles Pedregal. Ciudad de México, México.

2 Médico radiólogo, adscrito al Departamento de Radiología e Imagen. ORCID: 0000-0001-9449-4600.

3 Médica residente de segundo año del Curso de Especialización y Residencia en Radiodiagnóstico. ORCID: 0009-0006-1253-5012.

4 Médica residente de tercer año del Curso de Especialización y Residencia en Radiodiagnóstico. ORCID: 0000-0002-0375-9974.

5 Personal técnico radiólogo. Especialista en TC. Departamento de Radiología e Imagen.



If you wish to consult the supplementary data for this article, please contact editorial.actamedica@saludangeles.mx



CORRESPONDENCE

Dr. Gaspar Alberto Motta Ramírez. Correo electrónico: radbody2013@yahoo.com.mx




Received: 2024-11-13. Accepted: 2025-01-27.

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