Acute pulmonary embolism

Case contributed by Dr Oyedepo Victor Olufemi


Chest pain and difficulty breathing.

Patient Data

Age: 75 years
Gender: Male

A nearly occlusive eccentric filling defect is seen in the right main pulmonary artery in the arterial phase. A smaller non occlusive filling defect is also seen in the left main pulmonary artery and in the segmental artery to the lingular lobe. 

There is moderate acute dilatation of the right ventricle.
No pleural effusion or lung consolidation.

Case Discussion

Pulmonary embolism is occlusion of the pulmonary arterial systems seen on arterial phase of a pulmonary angiographic study as filling defect. Central or eccentric filling defect making an acute angle with the vessel wall and  surrounded by a rim of contrast is typical of acute pulmonary embolism.

Emboli can be located within the central pulmonary artery, main, lobar segmental, subsegmental and may  be occlusive or non-occlusive.

Acute right sided heart failure is known to be responsible for circulatory collapse and death in patient with severe embolism and this can be assessed more accurately at CT pulmonary angiography by measuring the right ventricular diameter and left ventricular diameter ratio (RVD:LVD) on a reconstructed four chamber view. 

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