Pulmonary embolus and subclavian artery thrombus

Case contributed by Dr Jeremy Jones

Presentation

Achilles rupture 4 weeks previously. Immobilised left lower leg. Increasing breathlessness for 48 hours. On therapeutic low-molecular weight heparin.

Patient Data

Age: 65
Gender: Female
X-ray

Initial plain film

Hiatus hernia.  Prominent pulmonary arteries, but clear lung fields.

Massive bilateral emboli in both main pulmonary arteries and the dependent branches.  Additional clot within the left subclavian artery with 5 cm of thrombus protruding into the aorta.

Subsequent questioning elicited 12 hour history of left arm ischemic-type symptoms including claudication.

Case Discussion

Extensive pulmonary emboli and a thrombus in the left subclavian artery.  The thrombus in the subclavian does not look native and has the same appearance as the clot in the pulmonary system. 

Echo confirmed raised pressures.

We theorized that extensive clot burden increased right heart pressures.  A patent foramen ovale (PFO) allowed a paradoxical embolus to lodge within the left subclavian artery.

The left subclavian clot was removed by the interventional radiologists and thrombolysis was administered for the PE.

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Case information

rID: 14402
Published: 21st Jul 2011
Last edited: 1st Mar 2019
Inclusion in quiz mode: Included

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