incidentalomas are sometimes clues

9 Dec

interesting case in June’s EMN mag, makes you think twice about supposed “incidental” findings on your CTs and other imaging…

 

CASE HIGHLIGHTS:

55 yo male with Down Syndrome

brought by EMS for near-syncope (eyes rolled up into back of his head, and began breathing funny) an hour earlier

only complaint afterward was diffuse abdominal pain (present on exam, too)

caregiver not present in the ED

 

IV Contrast CT INCIDENTALOMAS:

  • large renal cyst
  • thickened duodenal bulb
  • small pericardial effusion
  • hiatal hernia
  • IVC is perfectly round, not oval
  • thickened pleura on right
  • inadequate contrast delineation of a small basal pulmonary vascular tributary

 

WHAT WAS THE DIAGNOSIS?

Saddle Pulmonary Embolism

filling defects to right & left main pulmonary arteries -> multiple peripheral pulm occlusions (including poor filling small tributary)

-> secondarily thickened pleura

-> small reactive pericardial effusion

RV Strain -> increased IVC pressure -> round IVC

 

BOTTOM LINE:

don’t automatically dismiss “incidental” findings; at least ponder them for a minute, they may sometimes be useful clues

click to the article (link below) for the narrative, and some other clues that pointed them in the right direction

 

References: EMN article; picture

 

 

 

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