Pulmonary embolism with right atrial thrombus

Presentation

Dyspnea, hypoxia and central chest pain.

Patient Data

Age: 70-75
Gender: Male

The lungs and pleural spaces are clear.  Moderate pulmonary congestion is noted.  No pneumothorax.  No subdiaphragmatic free gas.  No suspicious osseous lesion is identified.

Enlarged right inferior pulmonary artery (Fleishner's sign) with abrupt caliber change (Chang's sign), suggestive of pulmonary embolism.

There is thrombus within the right atrium, extending into the superior aspect of the inferior vena cava. There is possible extension of thrombus from the right atrium into the left atrium suggesting large ASD. Correlation with thoracic echo recommended. Pulmonary emboli are noted within the superior and inferior branches of bilateral pulmonary arteries.

There are a few pre-tracheal and para-aortic sub-cm mediastinal lymph nodes noted, however, no soft tissue mediastinal masses noted.

Case Discussion

Typical appearances of a large pulmonary embolus with evidence of right heart strain. Plain film displays Fleischner's/Chang's sign.

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