Wk 3, Case 21 - Review

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.