At our center all CTPAs are sent out with two main smooth kernel reconstructions. On the standard mediastinal window reconstruction pulmonary arteries are really bright, which facilites assessment of gross vessel patency, but it also increases CT blooming artifacts which can obscure e.g. small mural non-occlusive thrombi. Also note the marked streak artifact caused by dense contrast retained in the superior vena cava. The broader angiographic window is better at depicting wall irregularities and smaller thrombi.
Findings:
- saddle embolus of the main pulmonary trunk, with bilateral extensions into multiple segmental branches.
- moderately enlarged right ventricle.
- small pericardial effusion
- mild bibasal subsegmental partial atelectasis