case_images: PMC11831580_01
case_images: Pulmonary embolism on computed tomography angiography (CTA) chest. CTA Chest (mediastinal windows) demonstrating right main pulmonary embolism (red arrows) in the emergency department (left) vs initial hospitalization (right).
case_images: cureus-0017-00000077611-i01.jpg
case_images: PMC11831580_01_cureus-0017-00000077611-i01.jpg
case_images: FIG1
case_images: A repeat chest computed tomography angiography (CTA) in the emergency department (ED) redemonstrated the pulmonary embolism in the right pulmonary artery, which was slightly improved (Figure 1).
case_images: Pulmonary infarction & pleural effusions on computed tomography angiography (CTA) chest. Emergency department CTA chest (lung windows) of coronal (top) and axial (bottom) cuts showing pulmonary infarct (yellow arrows) and pleural effusions (red arrows). Formal radiologist interpretation: "Extensive right pulmonary emboli. No CT evidence of right heart strain. Wedge-shaped consolidations in the right middle lobe and right lower lobe suspicious for developing infarct. Small right pleural effusion."
case_images: cureus-0017-00000077611-i02.jpg
case_images: PMC11831580_01_cureus-0017-00000077611-i02.jpg
case_images: FIG2
case_images: In addition, there was worsening consolidation, thought to be pulmonary infarct, and small pleural effusions (Figure 2).
case_images: Worsening pulmonary infarct on rapid response. Comparison of axial cuts (A, B) and sagittal cut (C) of CTA Chest on initial ED imaging (left) vs rapid response (right) demonstrating worsening pulmonary infarct (yellow arrows), stable/slightly worsening small pleural effusions (red arrows). Formal radiologist interpretation: "Redemonstrated right main pulmonary trunk and right lower lobe segmental pulmonary emboli. No evidence of right heart strain. Evolving right lower lobe pulmonary infarct. Right pleural effusion, increased compared to prior."
case_images: cureus-0017-00000077611-i03.jpg
case_images: PMC11831580_01_cureus-0017-00000077611-i03.jpg
case_images: FIG3
case_images: A third CTA chest was performed showing stable pulmonary embolism but worsening consolidations and pleural effusions (Figure 3).
case_images: Aspiration thrombectomy. Thrombus removed with aspiration thrombectomy (A - top, red arrows). Angiogram showing no flow in the right pulmonary artery (B - bottom left, blue arrows). Restoration of flow after aspiration thrombectomy (C - bottom right, yellow arrows).
case_images: cureus-0017-00000077611-i04.jpg
case_images: PMC11831580_01_cureus-0017-00000077611-i04.jpg
case_images: FIG4
case_images: Saturation 47.8%, Cardiac Output 3.58L/min, Cardiac Index 1.8L/min/m2, and Pulmonary Artery Pulsatility Index 1.5. A bilateral pulmonary angiogram was performed revealing a large occlusive embolus in the right main pulmonary artery. Aspiration thrombectomy (Indigo System, Penumbra, Inc., USA) was pursued yielding significant clot burden (Figure 4). Subsequent pulmonary artery pressures improved to 37/15mmHg (mean 24mmHg).