Saddle pulmonary embolism with right ventricular strain and right atrial thrombus (spectral CT)
Presentation
Cold sepsis, hypotensive.
Patient Data
Saddle pulmonary embolus with extensive clot burden expanding and involving the segmental arteries of all lobes. Moderate volume thrombus is also present within the right atrium. Right heart strain evidenced by enlargement of the right ventricle (RV/LV ratio: 1.88) and reflux of contrast into the hepatic and azygous veins. No enlargement of the main pulmonary trunk.
Subtle mosaic attenuation of the lungs in keeping with the multiple pulmonary emboli. Minor basal atelectasis. No pneumothorax or pleural effusion.
Trace pericardial effusion. No enlarged lymph nodes.
The imaged upper abdominal organs are unremarkable. No acute osseous abnormality. Thoracic kyphosis.
IMPRESSION
Saddle pulmonary embolus with extensive clot burden involving the segmental arteries of all lobes. Thrombus also present within the right atrium. Associated features of right heart strain.
Case Discussion
Extensive PE with clot in the right atrium.
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