CTICasesPatent Foramen Ovale (PFO) with Right Heart Strain from Pulmonary Embolism
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Imaging findings
A CT scan revealed a bright streak of contrast within the left atrium, specifically oriented towards its roof. Multiplanar reformatting confirmed this as a contrast jet emanating from a patent foramen ovale (PFO), indicative of right-to-left shunting. Additionally, mixing artifact ('smoke') was noted in the pulmonary veins and amorphous flow-related lines near filling defects in the pulmonary artery, distinct from discrete emboli.
Key takeaways
Acute elevation of right heart pressures, as seen in severe pulmonary embolism, can lead to the opening of a patent foramen ovale (PFO) and subsequent right-to-left shunting. A contrast jet directed towards the roof of the left atrium is a characteristic imaging sign of PFO, reflecting its anatomical path due to incomplete fusion of the septum secundum and primum. Such shunting can lead to paradoxical embolism, emphasizing the clinical importance of this finding. Differentiation between discrete filling defects (emboli) and flow-related mixing artifacts is crucial in pulmonary vascular imaging.
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