CTICasesPulmonary Embolism and Infarct in D-Transposition of the Great Arteries
Imaging findings
A patient with D-transposition of the great arteries repaired by an atrial switch (baffle) procedure was imaged for endocarditis and bacteremia. A non-contrast study shows a right pleural effusion and a wedge-shaped, focal dense ground-glass reverse-halo opacity, and a markedly abnormal adjacent pulmonary artery compared with the contralateral vessels. A cardiac CTA a month later shows the embolus organized, smaller, and remodeled.
Key takeaways
A wedge-shaped reverse-halo opacity together with a markedly abnormal, low-attenuation adjacent pulmonary artery allows a confident diagnosis of pulmonary embolism with infarction and hemorrhage, which in the setting of endocarditis may be septic or bland. Follow-up imaging showing the thrombus organizing and remodeling supports the diagnosis, though the reverse-halo appearance can also mimic angioinvasive fungal infection.
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