Presentation
Hemoptysis and left sided pleuritic chest pain.
Patient Data
Chest x-ray shows a pleurally based wedge-shaped opacity in the periphery of the left lower lobe which is referred to as the Hampton hump sign. There is also blunting of the costophrenic angles consistent with bilateral pleural effusions; left greater than right.
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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