Isolated Subsegmental Pulmonary Embolus Diagnosed by Multidetector-Row Computed Tomography
A 45-year-old man presented with increasing pain and swelling in his left calf after a long-distance flight. Ultrasound of the lower extremities revealed deep venous thrombosis in the left popliteal, posterior tibial, and peroneal veins. A regimen of low-molecular-weight heparin and warfarin was initiated. During a blood draw, the patient had a syncopal episode. The patient’s vital signs were remarkable for a Po2 of 94% on room air. Contrast-enhanced 16-slice multidetector-row CT pulmonary angiography with 0.75-mm slice thickness and 2D and 3D reconstruction revealed a single, isolated subsegmental pulmonary embolus (arrows) in the posterior basal subdivision of the left lower lobe (Figures 1 through 4⇓⇓⇓). Although the CT study confirmed the suspected pulmonary embolism, the patient’s syncopal episode was subsequently considered a vasovagal reaction, given the small size of the embolus. The patient was continued on anticoagulation therapy and was discharged 3 days later in stable condition.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.