Extensive acute pulmonary emboli with right heart strain

Case contributed by Michael P Hartung


Shortness of breath.

Patient Data

Age: 70 years
Gender: Female

Extensive acute bilateral pulmonary emboli nearly filling both right and left pulmonary arteries and involving all lobes. 

Borderline/mildly dilated main pulmonary artery, dilated right heart with flattening/bowing of the interatrial septum, and reflux of contrast into IVC and hepatic veins. 

Peripheral consolidation in the right lower lobe is likely an infarct. 

Case Discussion

Dilation of the right ventricle, bowing of the intraventricular septum, and reflux of contrast into the IVC/hepatic veins indicate right ventricular dysfunction due to extensive bilateral pulmonary embolus.

Reporting this finding can help the treatment team by prompting more careful hemodynamic monitoring and aggressive management. 

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