Positive and Negative CT Pulmonary Angiography Report Examples

A CT pulmonary angiography impression should not hide technical adequacy. A negative report states the arterial level that was assessed reliably. A positive report separately identifies the side, most proximal embolus level, and imaging findings associated with right heart strain.

Adapt every example to the images. Clinical severity, hemodynamic risk, and treatment decisions cannot be derived from CT alone. A critical acute embolus requires direct communication and documentation under local policy.

Assessment framework

• Diagnostic negative: No pulmonary embolus is identified through the segmental arterial level.
• Limited negative: No main or lobar embolus; segmental assessment is limited by motion.
• Positive: Acute embolus extends from the left lower lobar artery into segmental branches.
• Right heart: Increased RV/LV ratio and septal flattening are imaging signs of right heart strain.
• Chronic disease: Eccentric wall-adherent defects and intraluminal bands favor chronic thromboembolic disease.

What the report should contain

• Do not leave acute and chronic features unresolved in one vague sentence.
• For a subsegmental finding, state multiplanar confirmation and technical confidence.
• Describe morphology supporting pulmonary infarction without overstating certainty.
• Move an alternative acute diagnosis into the impression.
• Document the communication time and recipient when the reporting system permits.

Common errors

• Calling a limited examination globally negative.
• Describing embolus distribution only as small or large.
• Stating right heart strain without measuring or describing its signs.

Example report wording

Combined example impression: Acute pulmonary embolus is present in the right upper-lobe anterior segmental artery. No main or lobar embolus is identified. The RV/LV ratio is 0.8, without septal flattening or contrast reflux into the inferior vena cava. There is no peripheral finding of infarction. The result was communicated by telephone to the responsible clinician at 14:20.

First verify adequacy with the CTPA technical quality checklist.

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.