Exploring varied radiologic appearance in pulmonary embolism with CT pulmonary angiography: Case series with literature review

Abstract

Pulmonary embolism (PE) is a life-threatening condition caused by a sudden blockage of pulmonary arteries. Nonspecific and extremely variable clinical presentation frequently leads to undetected cases, making computed tomography pulmonary angiography (CTPA) hold a crucial role in the diagnosis of PE. This case series presents numerous types and findings of PE in CTPA among patients with different initial presentations followed by a literature review. We presented 3 cases with different initial presentations such as dyspnea with wheezing, productive cough, and hematemesis. All patients were consequently evaluated for D-dimer due to suspicion of PE from cardiac ultrasonography, electrocardiography (ECG), and persistent symptoms. Large to subsegmental PE can be found with various secondary findings such as pleural effusion and Hampton's hump. All patient's conditions were improved after anticoagulant treatment. This case series highlights the significance of CTPA as an imaging modality in the diagnosis of PE, as well as the necessity of evaluating the main to subsegmental pulmonary artery through an in-depth understanding of the images that can be assessed on CTPA.

Keywords: Case report; Computed tomography pulmonary angiography; High clinical suspicion; Pulmonary embolism; Radiologic findings.

Fig. 1

Two large thrombi on both sides of the main pulmonary artery. (A) Thrombi in the distal-bifurcation of the right and left pulmonary artery (white arrow), (B) Thrombus on the left pulmonary artery also covered the superior branch (white circle).

Fig. 2

Partial emboli on the right superior lobe with pleural effusion as the secondary findings. (A) Partial intraluminal filling defect in the posterior segmental branch of the right superior lobe suggestive of partial thrombosis or emboli (white circle), (B) Bilateral pleural effusion (white arrow).

Fig. 3

Two subsegmental pulmonary emboli on the right pulmonary artery. (A) Thrombus in the right pulmonary artery on the middle lobe lateral segment appears as a railway track sign (white arrow), and (B) posterior basal segment (open white arrow).

Fig. 4

Hampton hump as a secondary finding in SSPE patients. (A) Sagittal reformat, mediastinal window, (B) Coronal reformat, lung window showed a wedge-shaped opacity on posterior basal segment right lung (white circle, black circle).

Fig. 5

Minimal pleural effusion (white arrow head).