Case 21

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Clinical History:
The patient was an 11 year old male with nephrotic syndrome and a hypercoagulable state who developed respiratory distress.

Clinical Physical Exam:
Respiratory distress.

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Pneumonia

Imaging Findings:
A PA chest film showed a large wedge shaped infiltrate in the right lung and a right pleural effusion. A V/Q scan from the next day showed a large right lung V/Q mismatch. A pulmonary angiogram from the day after the V/Q scan showed a thrombus in the right pulmonary artery.

Image 1

Images 2 and 3

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Imaging Differential Diagnosis:
Pulmonary embolus

Operative Findings:
None

Pathological Findings:
None

Final Diagnosis:
Pulmonary Embolus / Pneumothorax, Loculated

Follow-up and Prognosis:
The patient had continued respiratory distress and subsequently developed a right sided empyema. One month after the diagnosis of pulmonary embolus was made the patient developed a rapidly expanding right pneumothorax and severe respiratory distress and had an unenhanced chest CT exam to investigate the extent of the pneumothorax. The right pneumothorax was found to be loculated, and was drained by interventional radiology who placed two chest tubes into the locules under fluoroscopic guidance. The lung re-expanded rapidly and the patient eventually recovered completely from the pulmonary embolus and is back playing goalie on his junior hockey team.

Image 5

Similar Cases:
Case 2

References:

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