Saddle pulmonary embolism on non-contrast CT

2021 ◽  
Vol 8 (2) ◽  
pp. 76-79
Author(s):  
Bilal Chaudhry ◽  
Kirill Alekseyev ◽  
Lidiya Didenko ◽  
Gennadiy Ryklin ◽  
David Lee
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Pulmonary Angiography ◽  
Pleuritic Chest Pain ◽  
History Of ◽  
Chest X Ray ◽  
Jugular Venous Distension ◽  
Low Probability ◽  
The Right ◽  
Contrast Ct

Background: A saddle pulmonary embolism (PE) is a large embolism that straddles the bifurcation of the pulmonary trunk. This PE extends into the right and left pulmonary arteries. There is a greater incidence in males. Common features of a PE include dyspnea, tachypnea, cough, hemoptysis, pleuritic chest pain, tachycardia, hypotension, jugular venous distension, and severe cases Kussmaul sign. The Wells criteria for PE is used as the pretest probability. Diagnostics include D-dimer levels, CT pulmonary angiography (CTPA), ventilation/perfusion scintigraphy (V/Q scan), echocardiography, lower extremity venous ultrasound, chest x-ray, pulmonary angiography, and electrocardiography (ECG). Case description: We present a 65-year-old male that presented with a two-week history of dyspnea with non-radiating intermittent chest pressure. Initial V/Q scan showed a low probability for PE, but a subsequent non-contrast CT revealed that he indeed had a saddle PE.

scholarly journals Acute Pulmonary Embolism Mimicking Covid-19 Pneumonia

2020 ◽  
Vol 2 (6) ◽  
pp. 1-2
Author(s):  
Benslima N ◽  
◽  
Kacimi M ◽  
Berrada S ◽  
◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Ground Glass Opacity ◽  
Ground Glass ◽  
Rt Pcr ◽  
Severe Respiratory Distress ◽  
Thoracic Ct ◽  
History Of ◽  
The Right ◽  
Contrast Ct

We report the case of a 21 years old male patient, with a history of asthma since the age of 8 months, without follow-up, presenting a severe respiratory distress appeared suddenly, associated with a right basithoracic pain, and moderate hemoptysis. The non-contrast CT-chest scan showed a basal ground-glass opacity of the right lung leading to suspicion of Covid 19s’ pneumonia. Laboratory tests reveal an elevated levels of D-dimers (D-D), a thrombocytopenia, a neutrophilic leukocytosis and a hyper eosinophilia. The molecular test RT-PCR is negative. With the persistence of the right-side basithoracic pain and the presence of a hyper eosinophilia and increased levels of D-Dimers. A thoracic CT angiography was indicated that shows a bilateral distal pulmonary embolism with a right-sided basal sub segmental ischemia. We discuss a fortuitous discovery of an idiopathic pulmonary embolism associated to peripheral basal ground-glass opacities similar to the radiological findings found in the case of a SARS-Cov-2 pneumonia.

scholarly journals Cough syncope and tracheal compression secondary to a retrosternal goitre: looking for a pulmonary embolism

2019 ◽  
Vol 12 (4) ◽  
pp. e228997
Author(s):  
Waqas Bin Majid Din ◽  
Eleanor Farrar ◽  
Cindy Liu ◽  
James Moor
Keyword(s):  
Ct Scan ◽  
Incidental Finding ◽  
Pulmonary Angiography ◽  
Tracheal Compression ◽  
Vein Thrombosis ◽  
Contrast Enhanced Ct ◽  
History Of ◽  
Chest X Ray ◽  
Contrast Ct ◽  
Deep Vein

A 51-year-old man presented acutely with recurrent bouts of coughing associated with transient and brief loss of consciousness consistent with cough syncope, mild stridor and a recent history of a respiratory tract infection. A chest X-ray demonstrated tracheal narrowing. His D-dimer was negative. A non-contrast CT scan of the chest demonstrated a large retrosternal goitre causing tracheal compression, and further investigation with a contrast-enhanced CT scan of the neck and chest demonstrated an incidental finding of a large pulmonary embolus (PE). The full extent of the PE was determined through performing a CT pulmonary angiography. Doppler ultrasound demonstrated a left leg deep vein thrombosis as the primary cause of the PE. His cough syncope improved in response to anticoagulation treatment, to the point where he could be safely discharged home. He had a further significant improvement in symptoms following an elective hemithyroidectomy for retrosternal goitre.

scholarly journals Computer Aided Detection of Pulmonary Embolism Using Multi-Slice Multi-Axial Segmentation

2020 ◽  
Vol 10 (8) ◽  
pp. 2945
Author(s):  
Carlos Cano-Espinosa ◽  
Miguel Cazorla ◽  
Germán González
Keyword(s):  
Pulmonary Embolism ◽  
False Positive ◽  
False Positive Rate ◽  
Pulmonary Arteries ◽  
Pulmonary Angiography ◽  
Blood Oxygenation ◽  
Computer Aided Detection ◽  
Point Selection ◽  
Computer Aided ◽  
The Right

Pulmonary Embolism (PE) is a respiratory disease caused by blood clots lodged in the pulmonary arteries, blocking perfusion, limiting blood oxygenation, and inducing a higher load on the right ventricle. Pulmonary embolism is diagnosed using contrast enhanced Computed Tomography Pulmonary Angiography (CTPA), resulting in a 3 D image where the pulmonary arteries appear as bright structures, and emboli appear as filling defects, with these often being difficult to see, especially in the subsegmental case. In comparison to an expert panel, the average radiologist has a sensitivity of between 77% and 94 % . Computer Aided Detection (CAD) is regarded as a promising system to detect emboli, but current algorithms are hindered by a high false positive rate. In this paper, we propose a novel methodology for emboli detection. Instead of finding candidate points and characterizing them, we find emboli directly on the whole image slice. Detections across different slices are merged into a single detection volume that is post-processed to generate emboli detections. The system was evaluated on a public PE database of 80 scans. On 20 test scans, our system obtained a per-embolus sensitivity of 68% at a regime of one false positive per scan, improving on state-of-the-art methods. We therefore conclude that our multi-slice emboli segmentation CAD for PE method is a valuable alternative to the standard methods of candidate point selection and classification.

Portable Ventilation/Perfusion Scanning is Useful for Evaluating Clinically Significant Pulmonary Embolism in the ICU Despite Abnormal Chest Radiography

2018 ◽  
Vol 35 (10) ◽  
pp. 1032-1038 ◽  
Author(s):  
Aaron S. Weinberg ◽  
William Chang ◽  
Grace Ih ◽  
Alan Waxman ◽  
Victor F. Tapson
Keyword(s):  
Pulmonary Embolism ◽  
Chest Radiograph ◽  
High Probability ◽  
Hemodynamic Instability ◽  
X Rays ◽  
X Ray ◽  
Abnormal Chest ◽  
Chest X Ray ◽  
Low Probability ◽  
Clinically Significant

Objective: Computed tomography angiography is limited in the intensive care unit (ICU) due to renal insufficiency, hemodynamic instability, and difficulty transporting unstable patients. A portable ventilation/perfusion (V/Q) scan can be used. However, it is commonly believed that an abnormal chest radiograph can result in a nondiagnostic scan. In this retrospective study, we demonstrate that portable V/Q scans can be helpful in ruling in or out clinically significant pulmonary embolism (PE) despite an abnormal chest x-ray in the ICU. Design: Two physicians conducted chart reviews and original V/Q reports. A staff radiologist, with 40 years of experience, rated chest x-ray abnormalities using predetermined criteria. Setting: The study was conducted in the ICU. Patients: The first 100 consecutive patients with suspected PE who underwent a portable V/Q scan. Interventions: Those with a portable V/Q scan. Results: A normal baseline chest radiograph was found in only 6% of patients. Fifty-three percent had moderate, 24% had severe, and 10% had very-severe radiographic abnormalities. Despite the abnormal x-rays, 88% of the V/Q scans were low probability for a PE despite an average abnormal radiograph rating of moderate. A high-probability V/Q for PE was diagnosed in 3% of the population despite chest x-ray ratings of moderate to severe. Six patients had their empiric anticoagulation discontinued after obtaining the results of the V/Q scan, and no anticoagulation was started for PE after a low-probability V/Q scan. Conclusion: Despite the large percentage of moderate-to-severe x-ray abnormalities, PE can still be diagnosed (high-probability scan) in the ICU with a portable V/Q scan. Although low-probability scans do not rule out acute PE, it appeared less likely that any patient with a low-probability V/Q scan had severe hypoxemia or hemodynamic instability due to a significant PE, which was useful to clinicians and allowed them to either stop or not start anticoagulation.

scholarly journals Pulmonary Tuberculosis mimicking a right Eventration on Radiography: The falsity of single view radiograph in the diagnosis of a precursor of pulmonary disease: A Case Report

2021 ◽  
Vol 4 (1) ◽  
pp. 33-37
Author(s):  
John Ogunkoya ◽  
Oluwatosin Yetunde Adesuyi
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lower Lobe ◽  
Middle Lobe ◽  
The Body ◽  
Single View ◽  
Lymph Node Enlargement ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
High Index Of Suspicion

Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology. Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs. Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon. Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.

scholarly journals Antiphospholipid Syndrome - A Case Report of Pulmonary Thromboembolism, Followed with Acute Myocardial Infarction in Patient with Systemic Sclerosis

2015 ◽  
Vol 3 (4) ◽  
pp. 705-709 ◽  
Author(s):  
Marija Vavlukis ◽  
Irina Kotlar ◽  
Emilija Chaparoska ◽  
Bekim Pocesta ◽  
Hristo Pejkov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Systemic Sclerosis ◽  
Antiphospholipid Syndrome ◽  
Total Occlusion ◽  
St Segment Elevation ◽  
St Segment ◽  
History Of ◽  
The Right

AIM: We are presenting an uncommon case of pulmonary embolism, followed with an acute myocardial infarction, in a patient with progressive systemic sclerosis.CASE PRESENTATION: A female 40 years of age was admitted with signs of pulmonary embolism, confirmed with CT scan, which also reviled a thrombus in the right ventricle. The patient had medical history of systemic sclerosis since the age of 16 years. She suffered an ischemic stroke 6 years ago, but she was not taking any anticoagulant or antithrombotic medications ever since. She received a treatment with thrombolytic therapy, and subsequent UFH, but, on the second day after receiving fibrinolysis, she felt chest pain accompanied with ECG changes consistent for ST-segment elevation myocardial infarction (STEMI). Urgent coronary angiography was undertaken, which reviled cloths causing total occlusion in 4 blood vessels, followed with thromboaspiration, but without successful reperfusion. Several hours later the patient developed rapid deterioration with letal ending. During the very short hospital course, blood sampling reviled presence of antiphospholipid antibodies.CONCLUSION: The acquired antiphospholipid syndrome is common condition in patients with systemic autoimmune diseases, but relatively rare in patients with systemic sclerosis. Never the less, we have to be aware of it when treating the patients with systemic sclerosis.

Primary pulmonary angiosarcoma

2021 ◽  
Vol 14 (11) ◽  
pp. e244578
Author(s):  
Muhammad Kashif Rana ◽  
Owais Rahman ◽  
Aiden O’Brien
Keyword(s):  
Pulmonary Arteries ◽  
Rare Type ◽  
Pulmonary Artery Sarcoma ◽  
Pulmonary Angiogram ◽  
Primary Pulmonary Artery Sarcoma ◽  
History Of ◽  
Ct Pulmonary Angiogram ◽  
The Right ◽  
Specific Symptoms ◽  
Large Primary

Primary pulmonary angiosarcoma is a rare type of malignant vascular tumour with poor prognosis. Diagnosis is often late due to non-specific symptoms and low clinical suspicion for angiosarcoma. A 72-year-old man presented to hospital with a 6-month history of mild progressive dyspnoea, with associated cough, episodes of presyncope and weight loss. CT pulmonary angiogram (CTPA) was reported as a large saddle pulmonary embolism extending into both the right and left pulmonary arteries. Further Multidisciplinary team meeting (MDM) discussion, and review of CTPA and subsequent investigations revealed a large primary pulmonary artery sarcoma which was later confirmed histology. The patient was referred to the cardiothoracic surgeons and underwent left radical pneumonectomy.

scholarly journals Castleman's Disease: An Intrapulmonary Form with Intrafissural Development

2009 ◽  
Vol 9 ◽  
pp. 940-945 ◽  
Author(s):  
Hajer Racil ◽  
Sana Cheikh Rouhou ◽  
Olfa Ismail ◽  
Saoussen Hantous-Zannad ◽  
Nawel Chaouch ◽  
...  
Keyword(s):  
Contrast Enhancement ◽  
Castleman’S Disease ◽  
Lower Lobe ◽  
Unknown Etiology ◽  
Castleman's Disease ◽  
Curative Surgery ◽  
Abnormal Shadow ◽  
History Of ◽  
Chest X Ray ◽  
The Right

Castleman's disease (CD) is an uncommon, mainly benign, lymphoproliferative disorder of unknown etiology, mostly involving the mediastinum. Parenchymal lung involvement of the disease is exceedingly rare. We describe a case of CD in a 23-year-old woman with a 4-year history of recurring dyspnea and nonproductive cough, whose chest X-ray showed an abnormal shadow of the right hilum. Chest computed tomography confirmed the presence of a tissue-density mass of the right lower lobe, demonstrating poor contrast enhancement, associated with multiple laterotracheal and mediastinal lymphadenopathies. The patient underwent curative surgery, revealing a right hilar compressive mass, with an intrafissural development between the superior and middle lobes. Pneumonectomy was performed due to profuse bleeding. This case of CD is particular because of its unusual intrapulmonary location and its intrafissural development. Poor contrast enhancement is atypical in CD.

scholarly journals P701 Usefulness of echocardiography in diagnosis and monitoring in patient with pulmonary embolism during pregnancy, a case report

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Starzyk ◽  
P Dybich ◽  
K Ciuraszkiewicz ◽  
W Rokita ◽  
B Wozakowska-Kaplon
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Troponin T ◽  
Pulmonary Arteries ◽  
Pulmonary Trunk ◽  
Clinical State ◽  
Main Trunk ◽  
Right Pulmonary Artery ◽  
Low Incidence ◽  
The Right

Abstract Pulmonary embolism is one of the leading causes of maternal mortality despite a low incidence of during pregnancy. We present 32-year-old woman, in the 35 week of first pregnancy, admitted to the Intensive Care Unit with dyspnea, tachycardia, cyanosis. Echocardiography confirmed the presence of embolic material in the main trunk of pulmonary artery, spreading to the right pulmonary artery. D-dimer and troponin T level were elevated, BNP remained within the normal range. The risk in PESI scale was assumed as intermediate high. LMWH therapy was initiated, the patient was constantly monitored. Venous thrombotic disease in lower extremities was excluded by ultrasonography. The treatment was carried out under obstetric supervision. The clinical state gradually improved, the patient was hemodynamically stable. Serial echocardiographic testing, revealed gradual regression of changes in the pulmonary trunk. Normalization of troponins and lowering of BNP levels were observed. The pregnancy was terminated in 39 week, by cesarean section (obstetric indications). The LMWH was continued few days after delivery, as the patient started lactation. She decided to terminate lactation in a first week after delivery so the therapy was switched into rivaroxaban for at least 3 months. Echocardiography after 3 month confirmed lack of changes in pulmonary trunk, the risk of pulmonary hypertension was low. Echocardiography can be a method of choice for confirming and monitoring pulmonary embolism during pregnancy, in a situation of high or intermediate clinical risk and good visualization of changes in pulmonary arteries Abstract P701 Figure. Embolism of pulmonary trunk and RPA

scholarly journals A rare cause of wheezing

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Alexander H. Cho ◽  
Jessica Logan ◽  
Jalil Ahari
Keyword(s):  
Granular Cell ◽  
African American Female ◽  
Lobe Bronchus ◽  
Submucosal Tumors ◽  
Sputum Production ◽  
Endobronchial Lesion ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
Tomography Scan

A 24-year-old African American female nonsmoker, with a reported history of asthma presented to the hospital with 2 weeks of shortness of breath and sputum production. She had a chest X-ray and computed tomography scan that displayed evidence of a right upper lobe collapse. She subsequently had a bronchoscopy that revealed an endobronchial lesion at the opening of the right upper lobe bronchus. Biopsies performed were consistent with a granular cell tumor. Granular cell tumors are rare submucosal tumors of Schwann cell origin. Resection of the right upper lobe resolved her symptoms and wheezing.

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