Pulmonary embolism

Case contributed by Dr Praveen Jha

Presentation

48 year old female presented with sudden onset breathlessness of four days after a neurosurgical intervention (MCA aneurysmal clipping)

Patient Data

Age: 48
Gender: Female
Modality: CT

Thrombus is visualised in right pulmonary artery, extending into upper lobar branch, descending pulmonary artery, segmental and subsegmental branches in lower lobe.

Case Discussion

A 48 year old female presented to the out-patient department with intense headache since few days. Non-contrast CT imaging of head revealed a hyperdense attenuation area in right sylvian fissure. CT angiography showed a saccular aneurysm in right middle cerebral artery. Patient went for aneursymal clipping.

Patient had dilated pupils, immediately after surgery. Post-operative CT shows post-operative hematoma in basal cistern, with edema and subarachnoid hemorrhage. No significant mass effect is seen. Patient started obeying commands next day.

4 days post-operatively, patient had a sudden episode of hypoxia. Screening doppler of lower limbs does not reveal any deep venous thrombosis. Pulmonary angiography was advised with strong suspicion of pulmonary embolism.

Pulmonary angiography showed thrombus in right pulmonary artery, extending into upper lobar branch, descending pulmonary artery, segmental and subsegmental branches in lower lobe.

Patient underwent embolectomy, and diagnosis was confirmed.

Note: Incidental detection of polycystic liver

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Case Information

rID: 13529
Case created: 19th Apr 2011
Last edited: 31st Oct 2015
Systems: Cardiac, Chest
Inclusion in quiz mode: Included

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