Extensive acute pulmonary emboli with right heart strain

Case contributed by Michael P. Hartung
Diagnosis certain

Presentation

Shortness of breath.

Patient Data

Age: 70 years
Gender: Female
This study is a stack
Axial
C+ CTPA
This study is a stack
Coronal
C+ CTPA
This study is a stack
Axial lung
window
This study is a stack
Sagittal
C+ CTPA
This study is a stack
Axial
Lung MIP
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Info

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 ventricle with flattening/bowing of the interventricular 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 interventricular 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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