A 48-year-old woman with worsening exertional dyspnoea and prior documented pulmonary embolism undergoes CT pulmonary angiography. Images show eccentric mural filling defects in both lower lobe pulmonary arteries, linear bands crossing the vessel lumina, and abrupt vessel calibre reduction. Right ventricular strain signs are absent. Which statement is correct?

• A Linear bands represent artefact from respiratory motion
• B The absence of right heart strain excludes clinically important disease
• C Central filling defects with sharp convex borders confirm acute embolism only
• D These are features of organised chronic thromboembolic disease ✓

Explanation

Eccentric mural thrombus forming obtuse angles with the vessel wall, webs and bands, and post-stenotic dilatation or abrupt calibre change are the recognised CT signs of organised chronic thromboembolic material. These patients may progress to chronic thromboembolic pulmonary hypertension despite absent right heart strain on a single study. Acute emboli form central defects with acute angles against the wall. Bands are true organised fibrous structures, not motion artefact.

Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.

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