CT Pulmonary Angiography Technical Quality and Reporting Checklist

A CT pulmonary angiography report should first state whether the examination can exclude emboli at the claimed level. A negative result can be falsely reassuring when pulmonary arterial enhancement, motion, respiratory artifact, and bolus timing are not considered. In a positive study, record the most proximal clot level and right heart findings.

This checklist addresses interpretation of a completed diagnostic examination. The decision to order CTPA depends on clinical probability, D-dimer testing, and appropriateness guidance. Chronic thromboembolic disease, postoperative change, and low-flow artifact can mimic acute embolus.

Assessment framework

• Review main pulmonary arterial enhancement and bolus timing.
• State how motion, noise, and flow artifact affect segmental branches.
• Trace main, lobar, segmental, and visible subsegmental arteries.
• Compare right and left ventricular diameters in an appropriate axial plane.
• Survey lungs, pleura, mediastinum, aorta, and upper abdomen for another diagnosis.

What the report should contain

• When embolus is present, name the side, vessel, and most proximal level.
• Describe clot burden by anatomic distribution rather than a vague adjective.
• Record RV/LV ratio, septal flattening, and contrast reflux when present.
• For possible pulmonary infarction, state the location of peripheral opacity and pleural fluid.
• In a negative study, define the lowest reliably assessed arterial level.

Common errors

• Calling one low-attenuation focus on a motion-degraded series an embolus.
• Reporting a limited segmental examination as completely negative.
• Deriving a clinical risk class from imaging alone.

Example report wording

Example impression: The examination is diagnostic through the segmental arterial level. A central filling defect in the right lower-lobe posterior basal segmental artery is compatible with acute embolus. No main or lobar embolus is present. The RV/LV diameter ratio is 0.9, without septal flattening. A small peripheral wedge-shaped right lower-lobe opacity may represent infarction.

Compare the final wording with the acute pulmonary embolism reporting guide.

References

1. American College of Radiology. Appropriateness Criteria: Suspected Pulmonary Embolism. Source (opens in a new tab)
2. American College of Radiology. Practice Parameter for Thoracic CT. Source (opens in a new tab)

Clinical note: This material is for radiology education. Do not generate an automatic diagnosis or management decision without checking guideline scope, patient factors, and local policy.