CTICasesIn-Situ Thrombus in Eisenmenger Syndrome
Imaging findings
CT chest in a patient with Eisenmenger syndrome shows a massively dilated main pulmonary artery with extensive mural calcification and a large, non-obstructive, layering eccentric in-situ thrombus in the central pulmonary arteries.
Key takeaways
Eisenmenger syndrome (reversed congenital shunt with severe pulmonary hypertension) leads to low-velocity, sluggish blood flow and severe endothelial dysfunction in the dilated central pulmonary arteries. This environment promotes the development of large, calcified in-situ thrombi, which should not be misdiagnosed as acute emboli (avoiding unnecessary thrombolysis or surgical embolectomy).
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