Presentation
Acute onset of shortness of breath and chest pain. Fast deterioration of respiratory and cardiac function and admitted to ICU.
Patient Data
The pulmonary artery demonstrates an increased diameter and a large hypodense filling defect at the bifurcation of the main pulmonary trunk, extending into both major trunks (more on the left side).
The left major trunk is occluded, with an abrupt cutoff in the upper lobe 1st order branch and nearly total occlusion at the 3rd order branches.
The right major trunk shows a linear intra-luminal floating filling defect causing partial occlusion, with an extended abrupt cutoff in the inferior 1st-order branch, and total occlusion down to the 3rd-order branches.
Scattered areas of reduced oligemia in the middle and basal segments on both sides, with no significant infarction.
Case Discussion
Features of saddle pulmonary artery embolism, with right major trunk floating thrombus as described.
Maximum intensity projection (MIP) reconstruction plays an important role in the detection and tracing of small arterial branches that enable the detection of subtle occlusions.
A major complication is right-side heart strain and impending failure. In our case the increased caliber of the major trunk and left main branch are early signs of right ventricule strain.
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