Acute-on-chronic pulmonary emboli

Case contributed by RMH Core Conditions

Presentation

Type 2 respiratory failure. TTE - large RV with decreased function, pulmonary hypertension and moderate TR. ?PE.

Patient Data

Age: 60
Gender: Female

Pulmonary angiogram

CT

Port in the right side of the chest noted.

There are multiple filling defects in the segmental branches of the right upper, middle and lower lobes and the left lower lobe. The most proximal embolus is a small embolus at the bifurcation of the right main pulmonary artery.

The pulmonary artery is dilated (3.7cm) and there is reflux of contrast into the hepatic veins in keeping with the stated history of pulmonary hypertension.

Atelectasis is noted in the lung bases. There are small bilateral pleural effusions. Changes consistent with centrilobular emphysema noted in the lung apices.

Impression

Multiple pulmonary emboli, predominantly segmental and likely representing a combination of acute and chronic emboli. Evidence of pulmonary hypertension.

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