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Electron beam tomography of an interpulmonary saddle embolus
  1. C N H Enzweiler,
  2. A E Lembcke,
  3. B Hamm

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A 63 year old woman with a history of gastrectomy for gastric cancer and locally recurrent and metastatic disease presented to the ER with progressive shortness of breath and left sided chest pain. At physical examination the patient had a heart rate of 84/min and was mildly tachypnoeic. The ECG was normal. At Doppler ultrasound the patient had bilateral deep venous thrombosis (DVT) of the legs. An electron beam tomographic (EBT) study of the chest was performed to rule out pulmonary embolism. The EBT study (panel A) showed a large pulmonary embolus extending across the bifurcation of the main pulmonary artery (PA) into both lungs (interpulmonary saddle embolus; arrow). The volume rendered image (panel B) provides an angioscopic view from the main PA into the right and left PA demonstrating extension of the embolus across the bifurcation of the main PA (straight arrow) into the right lower lobe artery (curved arrow). The right atrium and right ventricle, however, were not dilated which was confirmed by echocardiography. There was a pre-existing malignant pleural effusion on the left (* in panels A and C). Anticoagulation therapy was implemented and clinical symptoms subsequently resolved. A follow up EBT study (panel C) performed 14 days after the initial scan shows complete resolution of the saddle embolus at the level of the main PA.

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