ElectricPE: The Diagnosis of Pulmonary Embolism: Case Study 23
Jeffrey R. Galvin, M.D. and James J. Choi, B.S.
Peer Review Status: Internally Reviewed
One month prior to admission he developed a cough, dyspnea on exertion, blood tinged sputum and back discomfort. A work up at his local hospital revealed poorcardiac function on a nuclear medicine study and was given the diagnosis of Òcongestive cardiomyopathyÓ.
He was transferred to the cardiovascular ICU at this hospital because of increasing dyspnea, lower extremity edema and chest discomfort.
His chest radiograph revealed low lung volumes, cardiomegally, and
bilateral hazy lower lobe densities consistent with pulmonary
congestion. 
After 2 days of intensive diuresis the patients symptoms continued
without improvement. He was therefore, referred to the CineCT
(Imatron C-100) to assess both right and left ventricular function.
During the acquisition of the cardiac images it was noted that the
patients lung fields were abnormal and suggested the presence of
multiple pulmonary infarcts.
The cine
CT showed a reduced left ventricular ejection fraction and clots in
the apices of both ventricles.
Case Assessment
This is a 36 year old male construction worker who suffered chest
trauma and probable cardiac contusion. He presented to this hospital
with dyspnea, cough, blood tinged sputum, and back pain.
1. The findings in this case of pulmonary embolus were difficult to differentiate from pulmonary congestion due to cardiac failure. It was apparent after he was anticoagulated that all of his acute symptoms were due to the multiple pulmonary infarcts.
2. The chest x-ray although grossly abnormal was misinterpreted as
consistent with pulmonary congestion. The chest CT was quite helpful
in improving the specificity of the chest X-ray.
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