Case 1 - Pulmonary Embolism - Approach to CT Pulmonary Angiography

EXAM: CT Chest w/ Contrast
CLINICAL INDICATION: PE Protocol;Acute shortness of breath.
TECHNIQUE: Non-gated spiral axial images of the chest were obtained with
nonionic intravenous contrast according to a pulmonary embolism protocol. If
applicable, point-of-care testing was approved following departmental protocol.
There were no immediate complications reported.
FINDINGS:
PULMONARY ARTERIES:
Extensive acute partially occlusive and nonocclusive filling defects identified,
including large saddle pulmonary embolism in the left and right main pulmonary
arteries, extending into lobar, segmental and subsegmental branches of all lobes
of the lungs.
MEDIASTINUM/HEART/VESSELS:
Heart is mildly enlarged with asymmetric right atrial and right ventricular
enlargement and straightening of the interventricular septum. Pulmonary trunk
and thoracic aorta are normal caliber. No enlarged thoracic lymphadenopathy.
Unremarkable esophagus.
AIRWAY/LUNGS/PLEURA:
Trachea and main bronchi are clear. No focal consolidation, edema or pleural
effusion. Bibasilar subsegmental atelectasis. No pneumothorax. No suspicious
pulmonary nodule.
VISIBLE ABDOMEN:
Limited images of the upper abdomen demonstrate no acute abnormality.
SOFT TISSUES/BONES:
No aggressive osseous lesion or acute soft tissue abnormality.

IMPRESSION:
Positive examination for extensive acute pulmonary emboli, including large
saddle pulmonary embolus within the right and left main pulmonary arteries, with
clot extension into the lobar, segmental and subsegmental branches of all lobes
of the lungs. CT findings consistent with right heart strain. No pulmonary
infarction.
Critical findings were identified, read back and verified.