Sure, there’s a massive saddle PE, but what other related finding can you also see on this CTPA? Case contributed by Craig Hacking Full case discussion:

@drcraighacking - large PE with RV dilation, septal bowing, contrast reflux down to the liver - large clot-in-transit which I doubt this patient could tolerate if it embolized to the pulmonary arteries - this is close to the worst PE scan that someone can have & still be alive 😳

@PulmCrit @drcraighacking IVC reflux here is the probably worst sign here. Most objective finding of poor forward flow.

@drcraighacking Bowing of interventricular septum to the left, increased RV to LV ratio and reflux of contrast into the IVC and azygos vein i.e. right heart strain

@drcraighacking VCI and right atrial thrombuses

@drcraighacking Saddle PE, clot in RA, reflux on contrast into IVC/HV

@drcraighacking Cor pulmonale. RV > LV contrast reflux to supra-hepatic veins

@drcraighacking IVC thrombosis

@drcraighacking Ivc trombosis

@drcraighacking Right atrium thrombus extending to ivc

@drcraighacking @whocares Also #pfo