PMC7256686_01
Computed tomography pulmonary angiogram (CTPA). (a) Axial image. Low-density (grey) filling defect noted across the main pulmonary arterial trunk at its bifurcation. (b) Coronal image. Bilateral pulmonary emboli extending into all lobar and segmental branches. Arrows identify thrombus.
CRIM2020-7561986.001.jpg
PMC7256686_01_CRIM2020-7561986.001.jpg
fig1
Findings included saddle PE, extensive clot extending into lobar and segmental branches of all lobes (Figure 1) as well as evidence of right heart strain with marked right atrial (RA) and RV dilation as well as flattening and deviation of the interventricular septum.
Parasternal short-axis view at the mitral valve level, demonstrating a dilated right ventricle, a D-shaped interventricular septum, and a large multilobulated mass in the right ventricle (arrow). RA: right atrium; RV: right ventricle; LV: left ventricle.
CRIM2020-7561986.002.jpg
PMC7256686_01_CRIM2020-7561986.002.jpg
fig2
The right ventricular systolic pressure (RVSP) was 48.1 mmHg (Figure 2).
Parasternal short-axis view at the mitral valve level, performed on the day following thrombolysis. Note the absence of both the thrombus and the D-shaped interventricular septum. RA: right atrium; RVOT: right ventricular outflow tract; LV: left ventricle.
CRIM2020-7561986.003.jpg
PMC7256686_01_CRIM2020-7561986.003.jpg
fig3
Serial echocardiograms at 2 hours after thrombolysis and the next day (Figure 3) demonstrated improvement in her RV function.