CTICasesAtrial Septal Defect with Eisenmenger Syndrome and Acute Pulmonary Embolism
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Imaging findings
Initial CT from December shows a massively enlarged main pulmonary artery, a large secundum atrial septal defect (ASD), severe right-sided chamber hypertrophy and dilatation, and clear, non-adherent filling defects in the central pulmonary arteries with a left upper lobe pulmonary infarct. A follow-up CT shows residual eccentric wall thickening (chronic thrombus or plaque) without the acute non-adherent filling defects.
Key takeaways
Patients with a large atrial septal defect (ASD) and Eisenmenger syndrome are at increased risk for thromboembolic events and in situ pulmonary artery thrombosis due to hypercoagulability (especially during pregnancy), sluggish flow, and endothelial dysfunction. Distinguishing acute embolic pulmonary embolism from chronic in situ thrombosis can be challenging, but acute emboli typically present as non-adherent, central filling defects, whereas chronic/in situ lesions are eccentric and wall-adherent.
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