“Pulmonary Vein Sign” for Pulmonary Embolism Diagnosis in Computed Tomography Angiography

Purposes Considering that pulmonary arterial obstruction decreases venous flow, we hypothesized that filling defects in pulmonary veins can be identified in areas adjacent to pulmonary embolism (PE). This sign was named the “pulmonary vein sign” (PVS), and we evaluated its prevalence and performance for PE diagnosis in computed tomography pulmonary angiography (CTPA). Methods This retrospective study enrolled consecutive patients with clinical suspicion of PE who underwent CTPA scan. The PVS was defined by the following criteria: (a) presence of a homogeneous filling defect of at least 2 cm in a pulmonary vein; (b) attenuation of the left atrium > 160 Hounsfield units. Using the cases that presented PE on CTPA as reference, sensitivity, specificity, and positive and negative predictive values were calculated for PVS. Results In total, 119 patients (73 female; mean age, 62 years) were included in this study. PE was diagnosed in 44 (35.8%) patients. The PVS was present in 16 out of 44 patients with PE. Sensitivity was 36.36% (95% confidence interval (CI) 22.83–52.26%); specificity, 98.67% (95% CI 91.79–99.93%); positive predictive value, 94.12% (95% CI 69.24–99.69%); negative predictive value, 72.55% (95% CI 62.67–80.70%). The Kappa index for the PVS was good (0.801; 95% CI 0.645–0.957). PVS was correlated with lobar and segmental pulmonary embolism ( p < 0.01). Conclusion Despite a low sensitivity, presence of the pulmonary vein sign was highly specific for PE, with a good agreement between readers. This sign could contribute for PE diagnosis on CTPA studies.