Optimizing Computed Tomography for Detection of Pulmonary Thromboembolism in Patients With Fontan Circulation

Radwan S, Gill GS, Ghazzal A, Barnett C.Cureus. 2020 May 28;12(5):e8326. doi: 10.7759/cureus.8326.PMID: 32499987 Free PMC article.



Congenital heart disease (CHD) patients who have undergone the Fontan procedure or one of its variants usually have altered vascular anatomy. Consequently, this poses a challenge when diagnosing pulmonary thromboembolism (PTE) with computed tomography (CT). Detailed review of the type of surgery performed and the person’s individual anatomy beforehand can help in choosing the appropriate diagnostic CT modality and technique. It would also help reduce false-positive and false-negative test results that would otherwise result in unnecessary anticoagulation, as well as avoid needless radiation exposure and additional cost, respectively.


Figure 1. Electrocardiogram demonstrating sinus tachycardia.


Figure 2. Chest radiography demonstrating pulmonary venous congestion.


Figure 3. Axial CT pulmonary angiogram demonstrating SVC to be contiguous with the right PA with clear opacification (solid arrow line in panes A and B) and also shows IVC to be contiguous with the left PA, but without any opacification (dotted arrow line in panes C and D). SVC: superior vena cava; PA: pulmonary artery; IVC: inferior vena cava