Pulmonary Embolism

1. Case Study
Slam
201002414
MBBS IV

2. Case Summary
• Ms K.M, a 39 year old female, HIV +ve on
ATRIPLA with a 1 week history of haemoptysis
and SOB following a right leg DVT
• Diagnosis: ? Recurrent Pulmonary Embolism

3. Imaging Investigations
• CXR usually normal
– Atelectasis or pleural effusion may be present
– Classic signs such as hampton’s hump or
westermark’s sign are very rare
• Duplex u/s of the leg
– Half of cases are negative

4. Hampton’s Hump Sign

5. Venous Duplex U/s

6. CT-PA
• CT-Pulmonary Angiography has a sensetivity
of > 90%
• Visualise clots as small as 2mm
• It is a Gold Standard

11. Indications For CT-Angiography
• Pulmonary Embolism
• Left ventricular stress/failure
• Aortic Dissection
• Teratology of Fallot
• Aortic overloading

12. • Invasive and costs so..
• Usually reserved for patients in whom more
– information or certainty of the diagnosis of PE are
necessary.

13. Indications for CT-PA
• Indications are
– the need to confirm the diagnosis of PE in the
presence of
• contraindications to anticoagulation or
• if IVC filter placement or
• surgical embolectomy are contemplated

14. • In addition, patients with a
– high index of clinical suspicion but non-diagnostic
non-invasive studies and
– patients with pulmonary hypertension of
unknown cause

15. Contraindication for CT- Angio
• Renal failure
• Allergies to contrast
• Pregnancy
• Severe DM

16. • Life threatening complications are
– typically secondary to acute cor pulmonale in
patients with pre-existing severe pulmonary
hypertension and
– failing right ventricle.