Image Challenge

Section Editor

Dr. A. Nagarajan*

Department of Pulmonology, Kauvery Hospital, Cantonment, Trichy

*Correspondence: Email: nagapulmo@gmail.com

IMAGE CHALLENGE

History

A middle-aged man with no other comorbidities came with complaints of progressive exertional breathlessness since morning. He used to do routine walk for 5 km in a day. With the present condition, he could not make even 100 m without dyspnoea. He drove the car from Trichy to Chennai, on previous day to attend a family function, and returned to Trichy on same day after spending few hours in Chennai.

Associated illnesses

He had a cough with minimal sputum production and one episode of blood-stained sputum o the morning of the examination. No history of a similar episode in the past.

Investigation

At the time of presentation to the emergency room, he was dyspnoeic, tachypneic. His vitals recorded at the Emergency room were as follows: HR, 103/mt; BP, 110/90 mmHg; RR, 32/mt; Spo2, 85% on room air; requiring oxygen support of 2 L/mt to maintain spo2, 95%. CTPA is attached.

images

What is your diagnosis?

Answer

Computed Tomography Pulmonary Angiogram (CTPA) showed a contrast filling defect noted in the left main pulmonary artery. The thin rim of contrast that persists around a central filling defect due to the thrombus gives an appearance like that of popular UK mint sweet the Polo noted on the right descending pulmonary artery, also referred to as “Polo mint sign”.

CTPA findings were consistent with the diagnosis of Acute Pulmonary Embolism.

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