case_images: PMC11799482_01
case_images: CT pulmonary angiogram. a Coronal soft tissue window demonstrating straddling pulmonary embolism within the right lobar and proximal segmental upper lobe branch (black dotted arrow). The filling defect in the right upper lobe lobar artery (white arrow) is of similar density to chest wall subcutaneous fat (white star). b Axial soft tissue window demonstrating the heterogeneous appearance of the embolus, suggesting admixed bland thrombus (white arrow)
case_images: 42155_2025_521_Fig1_HTML.jpg
case_images: PMC11799482_01_42155_2025_521_Fig1_HTML.jpg
case_images: Fig1
case_images: A CT pulmonary angiogram showed multiple pulmonary emboli involving the distal right main pulmonary artery and right upper lobe proximal segmental branches (Fig. 1).
case_images: Macroscopic images of blood and tissue evacuated during large-bore mechanical thrombectomy. (a) Evacuated blood showing layering micelles and lipid droplets in the uppermost layer following filtration with the FlowSaver blood return system (Inari Medical, Irvine, California). (b) Top layer of evacuated blood with better presentation of the fatty layer (white arrow). (c) A macroscopic piece of fat which was aspirated and sent for histological assessment
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case_images: PMC11799482_01_42155_2025_521_Fig2_HTML.jpg
case_images: Fig2
case_images: Although only a small amount of soft tissue was retrieved, a layer of fat was seen in the aspirated blood, suggesting the emboli were fragmented by the suction effect and filtration through the Inari FlowSaver blood return system (Fig. 2).
case_images: Pulmonary angiograms taken before and after large-bore mechanical thrombectomy (a) Pre-thrombectomy angiogram confirming right main and right upper lobe filling defects corresponding to CT pulmonary angiogram findings. (b) Post-thrombectomy angiogram demonstrating resolution of central emboli with residual small volume subsegmental right upper lobe emboli
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case_images: PMC11799482_01_42155_2025_521_Fig3_HTML.jpg
case_images: Fig3
case_images: A post-thrombectomy pulmonary angiogram showed clearance of the central emboli, with residual subsegmental emboli too distal for retrieval (Fig. 3).
case_images: Histology of blood and tissue evacuated during large-bore mechanical thrombectomy. a Microscopy of retrieved tissue with haematoxylin and eosin staining showing possible adipocytes and fibrin calcification. b S100 immunohistochemistry showing focal nuclear staining of possible adipocytes adjacent to calcification
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case_images: PMC11799482_01_42155_2025_521_Fig4_HTML.jpg
case_images: Fig4
case_images: Histological assessment of the samples demonstrated thrombus with focal calcification and ischaemic focal adipocytes (Fig. 4).