Presentation
Male patient status post total hip replacement surgery. Developed shortness of breath.
Patient Data
There are large filling defects, likely acute thromboemboli, lodged in the bilateral main pulmonary arteries extending to the distal branches.
The right ventricle is prominent with flattening to slight bowing of the interventricular septum towards the left reflective of right heart strain. Reflux of contrast into the inferior vena cava is also observed.
Small wedge-shaped opacity, probably an infarct, is demonstrated in the right lung.
Case Discussion
This case demonstrates massive acute pulmonary thromboembolism resulting to right ventricular strain. Recent surgery and immobilization are known risk factors in developing deep venous thrombosis and subsequent pulmonary thromboembolism. D-dimer is not helpful in the postoperative patient as it is usually positive due to the surgery per se.
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