Case 2 - Pulmonary Embolism

EXAM: CT Chest w/ Contrast
CLINICAL INDICATION: PE Protocol;Chest pain unspecified.
TECHNIQUE: Multiple-row detector helical CT examination of the chest with IV
contrast. Axial, sagittal, and coronal reconstructed images. If applicable,
point-of-care testing was approved following departmental protocol.
FINDINGS:
Vascular: Evaluation of the pulmonary arteries is diagnostic to the subsegmental
arterial level. Large or nearly occlusive filling defect within the right main
pulmonary artery, slightly decreased in size when compared to prior, with
eccentric, nonocclusive filling defects within the right upper, middle, and
lower lobe segmental pulmonary arteries, similar to prior. The main pulmonary
artery is enlarged, similar to prior. The aorta is normal in course and caliber.
Mediastinum: Mild cardiomegaly with right ventricular and right atrial
enlargement. No pericardial effusion.
Lymph nodes: No pathologically enlarged thoracic lymph nodes.
Airways: Central airways are patent.
Lungs/Pleura: Patchy groundglass worse in the periphery of the right lower lobe
similar to prior exam and favored to represent tiny pulmonary infarcts. No
pulmonary edema. No pleural effusion. No pneumothorax.
Upper abdomen: Reflux contrast within the hepatic veins. Prior cholecystectomy.
Prior splenectomy.
Bones and soft tissues: Imaged thyroid gland is normal. No acute osseous
abnormality.
IMPRESSION:
1. Extensive likely subacute pulmonary embolism within the right lung extending
from the right main pulmonary artery to the segmental branches of the right
upper, lower, and middle lobes, similar to prior. Evidence of right heart
strain, similar to prior.
2. Likely tiny pulmonary infarcts most notably in the periphery of the right
lower lobe similar to prior exam.