Mechanical Thrombectomy for Progressive Pulmonary Infarction in Intermediate-Risk Pulmonary Embolism

Figures

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  Figure 1. 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).

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  Figure 2. 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."

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  Figure 3. 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."

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  Figure 4. 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).