Acute pulmonary embolism with pulmonary infarcts

Case contributed by Dr Mostafa El-Feky

Presentation

Left lower limb swelling and dyspnea.

Patient Data

Age: 55 years
Gender: Male
CT

CT pulmonary angiography

Multiple bilateral filling thrombi are noted affecting main pulmonary arteries with its main branches as well as their segmental and subsegmental divisions, consistent with extensive pulmonary artery thrombi. The early cardiac strain is noted, seen as straightening of interventricular septum and dilatation of right-sided heart chambers.

These are coupled with a sizable left upper lobe apicoposterior segment and right lower lobe superior and posterior segments consolidating lesions with preserved vascular and bronchial crossing structures and surrounded by patches of ground-glass opacities, likely pulmonary infarctions.

Case Discussion

Doppler examination of the venous system of both lower limbs on the same day revealed left popliteal deep venous thrombosis (DVT). In the acute setting and presence of extensive pulmonary arterial thrombi, the consolidating lesions are mostly representing acute pulmonary infarctions. Follow-up is recommended after one week as pulmonary hemorrhage would resolve, unlike infarctions that need months to resolve with a scar. Halo sign is present, however non-specific, seen as ground-glass opacity surrounding pulmonary lesions.

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Case information

rID: 77688
Published: 23rd May 2020
Last edited: 23rd May 2020
System: Vascular, Chest
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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