CT pulmonary angiography of adult pulmonary vascular diseases: Technical considerations and interpretive pitfalls

• CTPA plays a key role in the evaluation of pulmonary vascular diseases.
• Improvements in CT technology have improved visualization of pulmonary arteries.
• Knowledge of the technical pitfalls is essential for accurate diagnosis.
• Dual energy CT imaging enables parenchymal iodine evaluation.
• An awareness of the entities affecting the pulmonary arteries is important.

Computed tomography pulmonary angiography (CTPA) has become the primary imaging modality for evaluating the pulmonary arteries. Although pulmonary embolism is the primary indication for CTPA, various pulmonary vascular abnormalities can be detected in adults. Knowledge of these disease entities and understanding technical pitfalls that can occur when performing CTPA are essential to enable accurate diagnosis and allow timely management. This review will cover a spectrum of acquired abnormalities including pulmonary embolism due to thrombus and foreign bodies, primary and metastatic tumor involving the pulmonary arteries, pulmonary hypertension, as well as pulmonary artery aneurysms and stenoses. Additionally, methods to overcome technical pitfalls and interventional treatment options will be addressed.