Saddle pulmonary embolus with right heart strain

Case contributed by Dr Craig Hacking

Presentation

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Patient Data

Age: 45 years
Gender: Male

Large saddle emboli extending into the lobar pulmonary arteries bilaterally. Right heart strain is present, with enlargement of the RV and bulging of the interventricular septum.

ETT tip is above the carina. Minor left lingula atelectasis. No pleural or pericardial effusion. Enlarged mediastinal lymph node measures 12 mm in the short axis, at the aortopulmonary window. Imaged upper abdominal organs are unremarkable. No suspicious osseous lesion.

Case Discussion

Whenever PE is identified, the signs of right heart strain must be assessed for:

  • flattening of the interventricular septum or when more severe bowing of the interventricular septal towards the left ventricle
  • enlarged right ventricle (compared with the left ventricle)
  • enlarged pulmonary trunk (compared with the ascending aorta on the same axial slice
  • dilated hepatic veins +/- contrast reflux
  • inferior vena caval enlargement +/- contrast reflux
  • dilated azygous vein
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Case information

rID: 37208
Case created: 28th May 2015
Last edited: 27th Sep 2017
Systems: Vascular, Chest
Tags: pe, rv strain, ctpa
Inclusion in quiz mode: Included

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