Presentation
Sepsis from diverticulitis. CT abdomen showed basal PE.
Patient Data
Saddle pulmonary embolus with extensive clot burden expanding and involving the segmental arteries of all the lobes. Thrombus within the right atrium. Enlargement of the right ventricle (RV/LV ratio: 1.88), reverse bowing of the IV septum, and reflux of contrast into the hepatic and azygous veins. No enlargement of the main pulmonary trunk. Trace pericardial effusion.
Subtle mosaic attenuation of the lungs in keeping with the multiple pulmonary emboli. Minor basal atelectasis. No pneumothorax or pleural effusion.
No enlarged lymph nodes.
Impression
Saddle pulmonary embolus with extensive clot burden involving the segmental arteries of all lobes. Thrombus within the right atrium. Associated features of right heart strain.
Case Discussion
Large burden of pulmonary embolism. It is uncommon to find a thrombus in the right atrium.
Bilateral leg US confirmed occlusive DVT in the left popliteal vein.
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