Presentation
Patient experiencing breathlessness that came on acutely in last 24 hours. BP lower than previously recorded. Saturations 95% room air, ECG described as unremarkable. No previous chest imaging. Current smoker.
Patient Data
Patchy opacification at the right base.
No pneumothorax. Normal heart size.
No bony abnormalities.
Multiple bilateral pulmonary emboli, largest focus in right lower lobe. Evidence of right heart strain with dilatation of right ventricle and atrium.
Right basal consolidation is a possible site of infarction given distribution of emboli. Small right pleural effusion. Linear atelectasis in both lower lobes.
No airway compromise. No significant lymphadenopathy. Visualized abdomen unremarkable. No bony lesion.
Case Discussion
This patient had been an in-patient for over a fortnight and attended for review after a weekend at home. She described acute dyspnea and was borderline hypotensive with a normal heart rate.
On the basis of her symptoms and the scan, she was re-admitted and treated with low molecular weight heparin and warfarinised. Her d-dimer was in the thousands and re-examination of the ECG showed the S1Q3T3 phenomenon associated with pulmonary emboli.