Saddle pulmonary emboli with right ventricular strain and pulmonary infarct

Case contributed by Dr Craig Hacking

Presentation

Day 16 post CABG x3. Persistent tachycardia and hypoxaemia requiring high flow oxygen..

Patient Data

Age: 56
Gender: Male

There is adequate opacification of the pulmonary arteries, with a large saddle embolus identified extending into both right and left pulmonary arteries and further into the lobar and segmental arterial branches. There is flattening and bulging of the interventricular septum and dilatation of the right ventricle and pulmonary trunk which measures up to 33 mm, in keeping with pulmonary hypertension and right heart strain.

There are focal groundglass opacities peripherally in the right upper lobe along with a wedge-shaped region of atelectasis in the right apex which may represent subsegmental pulmonary infarction. There is also posterior left lower lobe atelectasis and consolidation and minor medial right lower lobe consolidation.

Sternotomy wires and mediastinal surgical clips noted, in keeping with recent CABG. Anterior mediastinal soft tissue oedema and fat stranding along with a small pericardial effusion are in keeping with post operative changes.

Reactive mediastinal lymph nodes noted.

The non-contrast-enhanced imaged abdominal viscera are unremarkable.

No suspicious osseous lesions. Mild degenerative changes noted in the thoracic spine.

Conclusion

  • Large saddle pulmonary embolus extending into multiple bilateral pulmonary arteries, with evidence of pulmonary hypertension and right heart strain.
  • Focal groundglass opacities and atelectasis in the right upper lobe along with posterior left lower lobe atelectasis/consolidation are in keeping with pulmonary infarction or infective changes.

Case Discussion

Great example of a saddle PE complicated by RV strain and pulmonary infarct.

This patient was treated with DSA embolectomy and had an IVC filter placed.

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Case information

rID: 35799
Case created: 24th Apr 2015
Last edited: 3rd Sep 2015
System: Chest
Inclusion in quiz mode: Included

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