Bilateral pulmonary emboli with Hampton hump sign

Case contributed by Dr Margaret Nguyen


Hemoptysis and left sided pleuritic chest pain

Patient Data

Age: 35
Gender: Female

CT pulmonary angiogram shows filling defects at the bifurcation of the right pulmonary artery with clot extending into the segmental and subsegmental branches of the right middle lobe, superior segmental branch of the right lower lobe and possibly within the basal segmental arteries of the right lower lobe. Filling defects are also seen in the subsegmental branch of the lingular artery, anterior and lateral basal segmental arteries of the left lower lobe.

No saddle embolus. No CT evidence of right heart strain. 

Patchy consolidation of the right middle and lower lobes. Near complete collapse/ consolidation of the left lower lobe. Moderate left pleural effusion and small right pleural effusion.

Case Discussion

This case demonstrates extensive bilateral pulmonary emboli with concurrent bilateral pleural effusions, lung infarction (Hampton hump sign) and possibly superimposed infection in the left lower lobe.

The patient subsequently underwent lower limb venous doppler ultrasound scans which confirmed bilateral calf deep vein thrombosis in the posterior tibial, soleus and peroneal veins.

She was treated initially with a low molecular weight heparin then changed to an oral direct factor Xa inhibitor. She also received a course of antibiotics. 

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Case information

rID: 54070
Published: 25th Jun 2017
Last edited: 14th Aug 2019
System: Chest
Inclusion in quiz mode: Included

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