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Radiological reasoning: pulmonary embolism--thinking beyond the clots.
Pierre D Maldjian1, Ather Anis, Muhamed Saric
1Department of Radiology, University Hospital, UMDNJ-NJ Medical School, 150 Bergen St., UH C-320, Newark, NJ 07103-2406, USA. maldjipd@umdnj.edu
AJR. American Journal of Roentgenology
|February 25, 2006
Summary
This case study highlights CT scan findings of pulmonary embolism complicated by paradoxical embolism. Radiologists should also examine the heart for associated conditions like patent foramen ovale.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Pulmonary Medicine
Background:
- Pulmonary embolism (PE) is a significant cause of morbidity and mortality.
- Computed tomography (CT) is the primary imaging modality for diagnosing PE.
- Paradoxical embolism is a rare but serious complication of PE.
Observation:
- A case of pulmonary embolism complicated by paradoxical embolism is presented.
- The patient had a patent foramen ovale and an atrial septal aneurysm.
- CT imaging revealed findings consistent with both pulmonary artery occlusion and intracardiac shunting.
Findings:
- CT demonstrated extensive pulmonary artery thrombi.
- Evidence of right-to-left shunting through a patent foramen ovale was observed.
- An associated atrial septal aneurysm was identified as a potential contributing factor.
Implications:
- This case underscores the importance of a thorough cardiovascular evaluation in patients with PE.
- Identifying underlying cardiac anomalies like patent foramen ovale is crucial for understanding embolic events.
- Radiologists should be vigilant for associated cardiovascular findings on CT to prevent recurrent embolic events.