PMC6042524_01
Enhanced CT scan of the abdomen.. a. Axial cut shows a heterogeneous parenchymal attenuation mainly affecting the right hepatic lobe with a filling defect involving the supra-hepatic and hepatic portion of the inferior vena cava (arrow).. b. Coronal cut shows extensive abdominal free fluid tracing into peri-hepatic and peri-pancreatic regions around the gallbladder fossa and Morison pouch as well as a dependent portion of the pelvis with a filling defect involving hepatic vein branches (arrow), consistent with acute Budd-Chiari syndrome.
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The patient had a contrast-enhanced CT of the abdomen (computed tomography), which showed heterogeneous parenchymal attenuation of enlarged liver with thrombosed hepatic veins as well as supra-hepatic and hepatic portions of the inferior vena cava in favour of BCS (Fig. 1).
CT angiogram of the chest.. a. CT chest angiogram shows segmental and subsegmental arterial branches of both lower lung lobes; namely, the rigSagittal reconstruction with 3-Dht posteromedial basal and left posterior basal segments show filling defects (arrows) in keeping with an acute pulmonary embolism.. b. Sagittal reconstruction with 3-D maximum intensity projection image, that further delineate the endoluminal thrombosis (arrow).. c. CT scan of the chest 3-D volume-rendered reconstructing display technique, seen from the anterior aspect, demonstrates multi-isolated peripheral filling defects denoting an abnormal vascular tree of the pulmonary arteries (arrows).
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The CT chest angiogram showed multifocal filling defects in keeping with an acute PE (Fig. 2).
Lung ventilation/perfusion study.. Lung ventilation/perfusion study using Tc-99 m MAA, which shows heterogeneous perfusion with perfusion deficits within segmental and sub-segmental territories of the posterior segments of the right upper and lower lobes as well as the apicoposterior, superior and posterobasal segments of the left upper and lower lobes, which confirm the diagnosis of embolism.
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Moreover, multiple large mismatched V/Q (ventilation/perfusion) segmental defects were identified (Fig. 3).