Chest pain on a background of immobilization due to tibial fracture.
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There is diagnostic contrast opacification of the pulmonary arteries. Bilateral extensive pulmonary emboli partially occluding both right and left pulmonary arteries and extending into their lobar, segmental and subsegmental branches involving all lobes. The thrombus in the right pulmonary artery lies close to its origin (but does not cross over to the left). There is reflux of contrast into the IVC, possibly representing early right ventricular dysfunction, however there is no bowing of the interventricular septum. Small 3 mm nodules are again demonstrated in the right upper and middle lobes, stable compared to the previous imaging. Minor bibasal atelectasis. Lungs are otherwise clear. No pleural effusion. There is no lymph node enlargement or other relevant mediastinal abnormality. Left breast surgical scar, skin thickening and left axillary surgical clips are again demonstrated.
Patient with strong clinical factors for pulmonary embolism with CT pulmonary angiography (CTPA) showing extensive filling defects within the pulmonary vasculature consistent with acute pulmonary emboli.