Faces of Pulmonary Embolus (PE) Acute

Infection
Infective Endocarditis
24 year old female with bacterial endocarditis with multiple pulmonary emboli, some cavitating. The CXR shows multiple foci of consolidation with a wedge shaped defect in the posterior segment of the left upper lobe consistent with a Hamptons hump caused by an embolic infarction
Ashley Davidoff MD TheCommonvein.net 24f PE Hampton’s hump 001
24 year old female with bacterial endocarditis with multiple pulmonary emboli, some cavitating. The CT shows multiple foci of consolidation with a foci of consolidations in the posterior segments of the upper lobes bilaterally The focal consolidation in the right upper lobe is cavitating
Ashley Davidoff MD TheCommonvein.net 24f PE Hampton’s hump 002
Septic Emboli Infarction Cavitation and Abscess Formation
CT scan in a 39 year old female with endocarditis presents with a fever and right sided chest pain.
Multiple views in axial (a,c) coronal (b) and sagittal reveals the presence of a wedge shaped consolidation with cavitation confirming the presence of an infected and cavitating infarction in the posterior segment of the left upper lobe. A loculated effusion is noted at the left base.
Ashley Davidoff TheCommonVein.net
b11422c
Septic Emboli Infarction Cavitation and Abscess Formation
CT scan in a 39 year old female with endocarditis presents with a fever and right sided chest pain.
Multiple view in axial (a,c) coronal (b) and sagittal confirm the presence of a wedge shaped consolidation with cavitation (red arrowhead a,b,c, and d)  confirming the presence of an infected and cavitating infarction in the posterior segment of the left upper lobe.  A second similar subsegmental infarct and abscess (yellow arrowhead, is noted in the right lower lobe (b yellow arrowhead) .  A loculated effusion is noted at the left base.
Ashley Davidoff TheCommonVein.net b11422cL

Neoplasm

Pulmonary neoplastic thrombotic microangiopathy caused by gastric adenocarcinoma in a 48-year-old man. (a) High-resolution CT scan shows multiple centrilobular nodules and branching lines with the tree-in-bud appearance (arrows), which is caused by tumor emboli. (b) Photograph of a cut section of the lung from an autopsy specimen shows normal interlobular septa (arrowheads) and pulmonary veins (PV) in the periphery of a secondary pulmonary lobule. Multiple branching opacities can be seen in the central portion of the lobule. (c) Photomicrograph (original magnification, ×400; hematoxylin-eosin stain) of a histopathologic specimen shows complete arteriolar occlusion by fibrocellular proliferation. Clumps of tumor cells are visible in the recanalized organized lesion (arrows). (Reprinted, with permission, from reference ,31.)
Rossi, SE et al Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview RadioGraphicsVol. 25, No. 3 2005

 

Circulatory

Main Pulmonary Arteries
Saddle Embolus 

Saddle embolus – Pulmonary arteries
This case of a saddle embolus shows a thrombus sitting astride the left and right pulmonary arteries.  Contemporary CTA is able to identify emboli in secondary and tertiary branches just as well.  CTA has  become the gold standard and study of choice in the patient with chest pain or acute desaturation with suspected PE.
Ashley Davidoff MD TheCommonVein.net  30008c
CT Acute Pulmonary Embolism (PE)
CT in the axial plane in a patient with acute dyspnea and chest pain shows embolic filling defects almost occluding the right pulmonary artery and partially occluding the left pulmonary artery consistent with acute occluding pulmonary emboli
Ashley Davidoff MD TheCommonVein.net 86257c
Axial CT – Pulmonary Embolus Left Lower Lobe
56 -year-old female with a history of amyloidosis presenting with tachycardia and dyspnea. CTPA shows an occlusive embolus (PE) in the left lower lobe pulmonary artery.
Ashley Davidoff MD TheCommonVein.net 135738c

Mismatched Ventilation- Perfusion (V/Q) Scan Multiple Bilateral Pulmonary Emboli

Mismatched Ventilation- Perfusion (V/Q) Scan Multiple Bilateral Pulmonary Emboli
28-year-old female on OCP with leg swelling, chest pain and dyspnea.
Previously performed CXR was normal. Perfusion scan (above) shows multiple bilateral perfusion defects which are not matched on the ventilation scan (below). These findings are consistent with multiple pulmonary emboli
Ashley Davidoff MD TheCommonVein.net 274Lu 11006c02
Mismatched Ventilation- Perfusion (V/Q) Scan CT Multiple Bilateral Pulmonary Emboli
28-year-old female on OCP with leg swelling, chest pain and dyspnea.
Previously performed CXR was normal. Perfusion scan (a) shows multiple bilateral perfusion defects (white arrowheads) which are not matched on the normal ventilation scan (b). These findings are consistent with multiple pulmonary emboli. CT scan through the upper and mid portions of the chest (c,d) confirm the presence of multiple occlusive and non-occlusive pulmonary emboli magnified and ringed (e,f)
Ashley Davidoff MD TheCommonVein.net 274Lu 11006c03L

PE and No Enhancement of the Left Lower Lobe Arterial Segments and Small Wedge Shape Infarction (Hamptons Hump)

Axial CT – Pulmonary Embolus Left Lower Lobe (PE)
56 -year-old female with a history of amyloidosis presenting with tachycardia and dyspnea. CTPA shows no contrast enhancement of the pulmonary arteries subtending the left lower lobe compared to the right and a subsegmental wedge shaped defect (Hampton’s hump) in the lateral segment of the left lower lobe
Ashley Davidoff MD TheCommonVein.net 135739c

PE and No Enhancement of the Left Lower Lobe-
Dual Energy Iodine Map

Dual Energy Iodine Map–
Perfusion Defect of the Left Lower Lobe from Occlusive Pulmonary Embolus
56 -year-old female with a history of amyloidosis presenting with tachycardia and dyspnea. Dual energy CT with an iodine map shows shows an almost lobar perfusion defect of the left lower lobe compared
Ashley Davidoff MD TheCommonVein.net 135740

 

Subsegmental Infarction

Subsegmental Infarction in the Lateral Segment of the Middle Lobe
CXR shows a wedge shaped infiltrate in the middle lobe of the lung secondary to a pulmonary embolus (PE) characteristic of a Hampton’s hump (maroon arrowheads a,b)  The infarction is confirmed on the CT with contrast (maroon arrowhead c) as well as the region of a perfusion defect (d- maroon arrowhead) In addition there is evidence of CHF on the CXR with cephalization of the vessels (white arrowheads c) cardiomegaly with left atrial enlargement, and enlargement of the azygous vein (blue arrowhead a) 
Ashley Davidoff MD TheCommonVein.net)

Segmental Infarction

CT Pulmonary Embolus Pulmonary Infarction 
Patient presented with dyspnea and chest pain. CTPA shows large pulmonary embolus subtending a region of right lower lobe infarction.
Ashley Davidoff MD TheCommonVein.net 19443L

 

Iatrogenic Coils

Post  Embolization of AVM in a Patient with Cirrhosis Hepatopulmonary Syndrome 
Courtesy Ashley Davidoff MD TheCommonVein.net 24137