Presentation
SOB and tachycardia. Bedside echo shows RV strain. Hx of PEs, obesity and OCP.
Patient Data
Good quality CTPA. Bilateral pulmonary emboli with occlusive and non-occlusive emboli extending throughout all of the lobar pulmonary arteries and into the subsegmental arteries. Overall large clot burden.
The pulmonary trunk is enlarged and the right ventricle is distended with flattening of the intraventricular septum. Egg and banana configuration of the pulmonary trunk and aortic arch. There is minor reflux of contrast into the IVC. Overall appearances are in keeping with acute right heart strain, concordant with severe clot burden.
Small peribronchial upper lobe opacities could represent small areas of pulmonary infarction.
No pericardial effusion.
No enlarged thoracic lymph nodes by CT size criteria.
No pneumothorax. No pleural effusions. No sizable pulmonary nodules.
The imaged portion of the upper abdomen is unremarkable.
No destructive bony lesion is identified in the thoracic skeleton.
IMPRESSION
Bilateral pulmonary emboli (occlusive or non-occlusive thrombi) wiht large clot burden
CT evidence of right heart strain
Bilateral upper zone peribronchial opacities could represent small areas of pulmonary infarction
Egg and banana configuration of the pulmonary trunk and aortic arch.
Case Discussion
As the pulmonary trunk enlarges with pulmonary hypertension (in this case due to PE), it takes on the appearance of an egg on the left of the curved (banana-shaped) aortic arch. This is the egg and banana sign.
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