Case 1023156
Clinical Presentation:
80 YO Female
DVT extending to the tip of the IVC. Patient with increasing breathlessness
Previous History:
-Chronic PE’s
-COPD
-home O2
-HTN
-Previous CVA IHD
Physical Examination:
-Swelling to L) LL for 4 days, more painful in groin
-Chest pain when coughing and increasing shortness of breath
-Legs equal in colour, L) LL 1.5x size. Equally warm. Palpable pulses. NV intact
Provisional Diagnosis:
IVC clot extending into the Left Femoral Vein
Imaging Performed:
CT Pulmonary Angiogram
- 100 mls Omnipaque 350 & 50mls saline @ 4mls/sec
Report Findings:
1. The imaging appearances favour subacute to chronic pulmonary emboli within the left lower lobe.
2. Complete segmental collapse involving the medial basal segment of the left lower lobe with abrupt cutoff of its associated bronchus may relate to sputum plugging or an obstructing lesion and bronchoscopy may be warranted.
3. Chronic pulmonary emboli are also seen within the right lower lobe.
CT Venogram -Abdomen (2nd pass)
- 120 seconds post CTPA
- 2nd pass as known LL DVTs & poor eGFR
Report Findings:
Completely occlusive left lower limb and pelvic DVT extending 2 cm above the confluence of the common femoral veins into the IVC.
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