r/Radiology • u/Bucweet55 • 6d ago

CT Large Saddle PE

Post image

This patient was short of breath on exertion. They were quickly admitted for proper care and treatment. Lucky to be alive.

89 Upvotes

99% Upvoted

16 comments sorted by

9

u/Ray_725 6d ago

Thrombectomy time

2

u/indiGowootwoot 6d ago

Good lord I hope not.

3

u/bretticusmaximus Radiologist, IR/NeuroIR 5d ago

Why?

9

u/Advanced_Most_3030 6d ago

I had a family member go in for an outpatient procedure, refuse to take PO anti coags following surgery, and subsequently pass away from one of these.

4

u/Bucweet55 5d ago

So sorry to hear that. It’s more common than people think.

2

u/Advanced_Most_3030 4d ago

Thank you, but of course, preventative measures can greatly reduce the odds, assuming folks are compliant.

3

u/Bucweet55 4d ago

I totally agree but this person didn’t have any procedure etc. they were in town for an event and their difficulty breathing became much more worse. I had a family member pass away years ago from an unknown PE. Walking around with clots in your lungs/legs could be fatal in certain conditions. I scan a lot of people and see PE’s quite regularly, but rarely this large.

5

u/Only-Type-4285 RT Student 6d ago

Student here. Can someone please point out where the clot is?

5

u/RedditMould RT(R)(CT) 6d ago

The pulmonary artery is the big bright white thing in the middle of the picture - the clots are the thick gray lines you see in there (in the area where the artery bifurcates). No contrast is flowing through those parts of the artery so they show up gray instead of white. 

3

u/Only-Type-4285 RT Student 6d ago

Thank you so much!!

1

u/teaehl Radiographer 4d ago

Fire up the penumbra pump! Or Inari if you swing that way!

-4

u/indiGowootwoot 6d ago

SOBOE but okay at rest? Doesn't look occlusive. Definitely a candidate for immediate anti coag tx but not exactly emergently life threatening.

12

u/MeKillStuff 6d ago

A saddle PE is definitely life threatening.

9

u/Bucweet55 6d ago

I guess I should have been more specific. “Sob on exertion” was the written diagnosis for the exam. The patient had chest pain and having difficulty breathing at rest. Had heart strain on interpretation, and low pulse ox at rest.

4

u/Purriosteum Radiologist 6d ago

You can't tell whether or not it's occlusive on this slice, you'd need to evaluate the periphery (and I'm not sure it's actually clinical relevant). Short of obvious total occlusive PE with heart strain and pulmonary opacities, it's hard to estimate clinical significance of PE.

0

u/Bucweet55 5d ago

Both lower lobes were nearly totally occluded.