Cardiology>>>>>Peripheral Vascular Disease
Question 47#

A 55-year-old woman presents to the ED with precordial chest discomfort and shortness of breath. Her body mass index is 34. Her medical history includes essential hypertension, diabetes mellitus type 2, and a 30 pack-year smoking history. Laboratory results include a troponin of 2.4 mg/mL and a B-type natriuretic peptide of 840 pg/mL. An ECG reveals no ST-segment elevation and nonspecific ST-T wave changes. The ED physician requests cardiology consultation for an NSTEMI. When you arrive to see the patient you order an IV contrast-enhanced chest CT scan of the lungs. Findings are demonstrated in Figure below.

What is the diagnosis?

A. Type A aortic dissection
B. Myocarditis
C. Pneumonia
D. Saddle pulmonary embolism
E. Interstitial lung fibrosis

Correct Answer is D

Comment:

Saddle pulmonary embolism. This patient has a pulmonary embolism involving both main pulmonary arteries. Massive and submassive pulmonary embolism can cause an increase in troponin and B-type natriuretic peptide as seen in acute myocardial infarction. The image shown illustrates a filling defect within the main pulmonary artery at the bifurcation. There are no findings suggestive of aortic dissection, pneumonia, or interstitial fibrosis.