PMC10196485_01
Chest CTA, axial (A,B), sagittal (C-F) images, showing locations of PE. On admission (A,C,E), images showing non-enhancing partial filling defects in bilateral pulmonary arteries extending into descending branches (red arrows). On the 6th day of antithrombotic therapy (B,D,F), images showing recanalization of the thrombosed vessels (green arrows). CTA, computed tomography angiography; PE, pulmonary embolism.
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Specifically, a computed tomography angiography (CTA) of chest demonstrated multiple intraluminal filling defects in the branch pulmonary arteries of both lungs, suggestive of PE in bilateral pulmonary arteries (Figures 1A,C,E), whereas no evidence of DVT was identified in bilateral lower limb veins by ultrasound. Radiographic recanalization of the infarcted pulmonary and cerebral vessels was identified on the 6th day (Figures 1B,D,F) and 20th day (Figures 2E-H) of antithrombotic therapy, respectively.
MRI and MRV, axial (A,E), sagittal (B,F,D,H) coronal (C,G) images, showing locations of CVST. On admission, T2-FLAIR MRI (A) and enhanced MRI (B), and MRV (C,D) images showing complete (partial) filling defect in superior sagittal sinus, straight sinus, vein of Galen, and torcula (arrows), together with absence of flow related signals where the sigmoid sinus (yellow circle), bilateral transverse sinus (yellow circle), and inferior sagittal sinus (red circle) normally existed. On the 20th day of antithrombotic therapy, T2-FLAIR MRI (E) and enhanced MRI (F), and MRV (G,H) images showing recanalization of the thrombosed vessels (arrows). Green arrow, torcula; red arrow, superior sagittal sinus; orange arrow, straight sinus; brown arrow, vein of Galen; yellow arrow, transverse sinus; blue arrow, sigmoid sinus; purple arrow, inferior sagittal sinus. MRI, magnetic resonance imaging; MRV, magnetic resonance venography; CVST, cerebral venous sinus thrombosis; FLAIR, fluid attenuated inversion recovery.
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Notably, multiple signal abnormalities were found in superior sagittal sinus, inferior sagittal sinus, straight sinus, bilateral transversal sinuses, bilateral sigmoid sinuses, vein of Galen, and torcula (Figures 2A-D), consistent with the imaging features of CVST. Radiographic recanalization of the infarcted pulmonary and cerebral vessels was identified on the 6th day (Figures 1B,D,F) and 20th day (Figures 2E-H) of antithrombotic therapy, respectively.
The timeline showcasing relevant data from the episode of care. CRP, C-reactive protein; PCT, procalcitonin; FR, fluid resuscitation; OS, oxygen supply; CTA, computed tomography angiography; MRI, magnetic resonance imaging; MRV, magnetic resonance venography; PE, pulmonary embolism; CVST, cerebral venous sinus thrombosis; LMWH, low molecular weight heparin; NS, nephrotic syndrome.
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Figure 3 summarized the Timeline with relevant data from the episode of care in this case.