A 52-year-old man with a 10 pack-year smoking history presents to the emergency department with acute onset dyspnea and pleuritic chest pain for 3 hours. He reports no leg swelling or pain. Vital signs: HR 118/min, BP 128/82 mmHg, RR 22/min, SpO2 89% on room air. Physical examination reveals clear lung fields bilaterally. Chest X-ray shows a wedge-shaped consolidation in the right lower lobe with a small pleural effusion. Laboratory studies reveal D-dimer 2.8 μg/mL (elevated), troponin I 0.08 ng/mL (normal), and normal hemoglobin and white blood cell count. ECG shows sinus tachycardia with no ST changes. He is taken for contrast-enhanced CT angiography of the pulmonary arteries. Which of the following findings is most consistent with the clinical presentation?

  1. A)Lack of pulmonary artery opacification with normal right ventricular size
  2. B)Filling defect within the right lower lobe pulmonary artery with Hampton's hump consolidationGABARITO
  3. C)Pulmonary trunk filling defect with acute right ventricular dilatation and right atrial enlargement
  4. D)Peripheral ground-glass opacities in bilateral lower lobes with pulmonary edema pattern
  5. E)Bronchial wall thickening and bronchiectasis with preserved pulmonary artery caliber

Explicação

The patient presents with classic features of pulmonary embolism with pulmonary infarction: acute dyspnea, hypoxemia, pleuritic chest pain, and a wedge-shaped consolidation on imaging (Hampton's hump—a radiologic sign of PE with infarction). The elevated D-dim... Ver explicação completa e trilha adaptativa →

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