Presentation
Cough for 1 month, dyspnea for 15 days, and syncope once.
Patient Data
Normal lung parenchyma.
Dilated right lower lobe pulmonary artery with internal hyperattenuation and distal oligemia.
Interlobular septal thickening in the left upper lobe.
Large right lower lobe pulmonary embolus and numerous additional bilateral pulmonary emboli.
Subtle inhomogeneity in lung attenuation.
Case Discussion
Pulmonary embolism should be considered for unexplained syncope.
Subtle alteration of the pulmonary vascular pattern and mildly hyperattenuating thrombus with arterial dilatation on non-contrast CT can be missed. Sometimes these findings are apparent on CXR.
Interlobular septal thickening is due to regional hyperperfusion.
Proximal emboli do not cause infarction if the bronchial artery collateral supply is adequate.
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