Pulmonary embolism

Case contributed by Dr Praveen Jha

Presentation

4 day history of sudden onset breathlessness after neurosurgical intervention (MCA aneurysm clipping).

Patient Data

Age: 50 years
Gender: Female

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

Case Discussion

Patient presented to the out-patient department with intense headache for a few days. Non-contrast CT imaging of head revealed a hyperdense attenuation area in right Sylvian fissure. CT angiography showed a saccular aneurysm in the right middle cerebral artery. Patient went for aneurysmal clipping.

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

4 days postoperatively, 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 the right pulmonary artery, extending into the upper lobar branch, descending pulmonary artery, segmental and subsegmental branches in the lower lobe.

Patient underwent embolectomy, and diagnosis was confirmed.

Note: Incidental detection of polycystic liver.

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