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CTPA PE

Technique: Helical CT scanning was performed through the chest during expiration with a standard delay of intravenous contrast. Contiguous 2.5 mm and 5mm transaxial images were obtained through the lungs. Reconstructed coronal and sagittal images were also obtained. Findings: Multiple partial filling defects are seen within the segmental and subsegmental pulmonary arteries involving all lobes of the bilateral lungs. The greatest involvement is seen in all subsegmental arterial branches of the right lower lung. There is no apparent involvement of the main, right or left pulmonary arteries. There is no abnormal bowing of the intraventricular septum. There is a wedge-shaped opacity involving the posterior superior aspect of the left lower lobe strongly compatible with infarct given the scenario. Minimally decreased areas of aeration noted in the right apex. Otherwise, there is no focal consolidation or mass. The heart and great vessels, and diaphragms are normal. There is no evidence of mediastinal, hilar or axillary lymphadenopathy. The visualized upper abdominal viscera and the osseous structures are unremarkable. Impression: 1. Bilateral segmental and subsegmental pulmonary embolism with greatest in the bilateral lower lobes. 2. No evidence of right heart strain. 3. Small infarct involving the posterior superior aspect of the left lower lobe. --------------------------------------------------------------- FINDINGS: Multiple partial filling defects are seen extending from the right main pulmonary artery into the segmental pulmonary arteries involving the right upper and lower lobes. Small defect in the left lower lobe subsegmental branch is also identified. Findings are consistent with acute pulmonary embolism bilaterally. There is bilateral pleural effusion with adjacent atelectasis, left worse than right. There are thickened interstitial septa consistent with pulmonary edema. Right apical and midlung central emphysematous changes are noted. Scattered air space and interstitial opacities in the left upper lobe are noted, and pneumonia or pulmonary edema cannot be excluded. Atherosclerotic vascular calcifications are seen throughout the aorta and its major branches. Right-sided dual-lumen dialysis catheter terminates within the right atrium. The heart and great vessels, pleura, and diaphragms are normal. There is no evidence of mediastinal, hilar or axillary lymphadenopathy. Visualized abdominal viscera demonstrate no definite abnormality. Mediastinal clips and median sternotomy wires are noted. Degenerative changes of thoracic spine are present. IMPRESSION: 1. Multiple bilateral pulmonary emboli as above. There is no evidence of right heart strain at this time. 2. Diffuse emphysematous changes with left greater than right pleural effusions and bibasilar atelectasis as above. Airspace and interstitial opacities in the left lung apex are noted and superimposed pneumonia or pulmonary edema cannot be excluded. 3. Postsurgical changes as above.