CTICasesChronic Pulmonary Thromboembolism with Tumefactive Organized Thrombus
Imaging findings
On a CT pulmonary angiogram obtained for suspected acute pulmonary embolism, there is no acute embolus, but a large, bulky filling defect is present in the left pulmonary artery with dilated branch points and internal high-attenuation material, probably contrast, possibly with some calcification; an irregular, wall-adherent, sand-dune-like filling defect is also present in the right main pulmonary artery, with more soft tissue than would be expected from usual lymphatic tissue, dilated vessels, and eccentric filling defects, without right ventricular dilation or hypertrophy.
Key takeaways
This pattern of dilated, bulky pulmonary arteries with organized, tumefactive-appearing eccentric filling defects and internal enhancement, without associated right heart strain, represents chronic pulmonary thromboembolism with an unusually bulky, possibly partially recanalized organized thrombus, an uncommon morphology that was not fully explained, since a systemic-to-pulmonary shunt or a pulmonary artery aneurysm with in-situ thrombosis were both considered but did not fit the clinical picture.
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