Two patients with dyspnea

 

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Doctor's Information

Name : Morteza
Family :Sanei Taheri
Affiliation : Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree: Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Maryam Shabani

 

Patient's Information

Gender : Male
Age : 50

 

Case Section

Cardiovascular

 

Clinical Summary

These two patients with chest pain and dyspnea underwent PCTA to be evaluated for suspected PTE

 

 

Imaging Findings

These two patients with chest pain and dyspnea underwent PCTA to be evaluated for suspected PTE. The first patient is a 55 year old man with chest pain and dyspnea and positive D-dimer and has the filling defect in the right main pulmonary artery with inferior extension. consolidation of basal segment is also noted due to emboli in its branches. Filling defects are in superior left lobe and inferior basal lobe branches. The second case is a 50 year old man with history of CHF and underwent recent amputation of the right lower limb, with negative D-dimer. Cardiomegaly (right sided) and bilateral pleural effusin with passive collapse consolidation in right and left lower lobes is seen, however no sign of PTE is detected . There is also immediate filling of supra hepatic IVC and hepatic veins because of reflux due to CHF.

 

Discussion (Related Text)

dynamic CT angiography of the pulmonary arteries (PCTA) using MDCT is the diagnostic modality for the evaluation of suspected PE. Emboli are recognized as intraluminal filling defects (case 1)ornonopacified vessels with a convex filling toward the proximal lumen. Secondary findings that can be seen on CT include peripheral oligemia (westermark sign),pleura-based wedge-shaped consolidation reflecting peripheral hemorrhage or infarct,linear atelectasis and pleural effusin.the detection of a high attenuation thrombus in the pulmonary arteries on unenhanced CT in patints with PE has been rarely described. In addition to the detection of emboli, up to two thirds of patients with acute chest symptoms who are studied with PCTA to exclude PE have an alternative diagnosis suggested by findings detected on CT (case 2) ,something not possible with techniques that only evaluate the pulmonary vasculature .

 

Final Diagnosis

case 1 is PTE- case 2 is CHF with reflux in hepatic vein

 

Differential Diagnosis

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References

Brant et al.fundamental of diagnostic radiology

 

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