Pulmonary embolism

Case contributed by Hani M. Al Salam
Diagnosis certain

Presentation

Cardiac MRI for pulmonary hypertension to rule out cardiac defects or shunts.

Patient Data

Age: 20 years
Gender: Male

Chest Radiograph

x-ray
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Info

Enlarged pulmonary trunk, lungs and pleural spaces are clear. 

Cardiac MRI

mri
This study is a stack
Axial
This study is a stack
Coronal T1
C+ fat sat
This study is a stack
Coronal T1
C+ fat sat
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Info

Bilateral segmental pulmonary artery emboli. 

CTPA

ct
This study is a stack
Axial
C+ CTPA
This study is a stack
Axial lung
window
This study is a stack
Coronal
C+ CTPA
This study is a stack
Sagittal
C+ CTPA
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Info

Bilateral pulmonary artery emboli. 

Signs of right heart strain are noted:

  • straightening of the interventricular septum

  • dilated pulmonary artery, in keeping with the development of pulmonary hypertension

  • contrast medium reflux into dilated IVC and hepatic veins

V/Q scan

Nuclear medicine
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Bilateral major mismatched defects consistent with high probability pulmonary embolism. 

Case Discussion

The patient was started on thrombolytic therapy and followed up by CTPA which demonstrated persistent bilateral pulmonary emboli without significant interval changes.

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