Presentation
A postpartum patient presented with sudden shortness of breath and pleuritic chest pain
Patient Data
The left pulmonary artery shows a filling defect of a large non-occlusive pulmonary embolus draped over the bifurcation of the left pulmonary artery, with complete occlusive involving the segmental branches, mainly the lower lobe and, to a lesser, extent the upper lobe, causing parenchymal lower lateral peripheral consolidative changes, suggesting acute pulmonary infarction with very minimal pleural effusion.
Normal right-sided pulmonary artery and its segmental branches.
Interrupted IVC with absent intrahepatic portion and continuation as dilated azygos vein from left lateral abdominal aorta just below the diaphragm and crossing midline posterior to descending thoracic aorta and esophagus at the level of T6 to join SVC.
There are rounded structures of isodensity and medial to the parent spleen as splenunculi.
Case Discussion
The finding of left-sided pulmonary embolism involving segmental branches causing pulmonary infarction and minimal left-sided pleural effusion.
Doppler ultrasound for assessment of both legs to exclude DVT.
There is an interruption of the intrahepatic/suprarenal portion of the IVC associated with a dilated hemiazygos vein, which drains into a dilated azygos vein that ascends in its usual course in the posterior mediastinum until it joins the superior vena cava. The infrarenal IVC was not included in the examination. There is an association with splenunculi as well.
Both azygos continuation of IVC and splenunculi, in our case, are normal anatomical variants and not a part of a heterotaxy spectrum.
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