CTICasesPulmonary Embolism Treated with Catheter Thrombolysis
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Imaging findings
A chest radiograph showed a Westermark sign. CT confirmed large bilateral pulmonary emboli with signs of right heart strain, including a dilated right ventricle, straightened interventricular septum, and a borderline enlarged pulmonary artery. EKG demonstrated ST segment depression. Pulmonary angiograms confirmed large filling defects in both pulmonary arteries. Post-thrombolysis angiograms showed substantial improvement and significantly smaller filling defects.
Key takeaways
Multimodality imaging (CXR, CT, EKG, echocardiography, and angiography) is crucial for evaluating severe pulmonary embolism. Signs of right heart strain are important indicators of severity. Catheter-directed thrombolysis with TPA can be an effective and rapid treatment for large pulmonary emboli, leading to substantial clot resolution and symptom improvement. Pulmonary angiography provides direct visualization of emboli and allows for confirmation of treatment efficacy.
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