Julia Gates MD and George Hartnell
Baystate Medical Centre; Springfield, MA
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Julia Gates MD and George Hartnell Baystate Medical Centre; Springfield, MA |
Fig. 1. Topogram image shows Hampton's hump (arrow). |
Fig. 2. Chest CT at lung windows showing peripheral consolidation corresponding to Hampton's hump seen in Figure 1. |
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This patient was admitted after complaining of right sided chest pain on presentation. His arterial blood gas was normal. A CTA was ordered for a work up of pulmonary embolus; the CT scan showed a Hampton's Hump on both the topogram (Figure 1) and the lung windows (Figure 2). CT angiography showed a clot straddling the pulmonary artery bifurcation (Figure 3). He was given Lovenox and to the floor. A house officer then consulted with the Radiology Department as to the appropriate next step; peripheral duplex Doppler sonography was advised. A basilic vein thrombosis was diagnosed by ultrasound; the lower extremity veins were clear. The patient then proceeded to complain of worsening chest pain and shortness of breath; he began to have hemoptysis. A pulmonary consult was ordered; the pulmonologist reported to the Radiology Department to review the images and asked for advice. |
Fig. 3. Image from CT angiogram showing long piece of thrombus straddling the pulmonary artery bifurcation.
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In view of the presence of a pulmonary infarct with this size clot and a basilic vein thrombosis would you:
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