CT Artifact Mimicking Pulmonary Embolism in a Patient with Single Ventricle

Excerpt

A 16-year-old male with known tricuspid atresia-type IB, who had previously undergone a lateral tunnel Fontan palliation presenting with chest pain, was referred to our hospital with massive pulmonary embolism (PE) based on computed tomography (CT) scan findings of a filling defect in the area of the superior vena cava (SVC) and pulmonary arteries with a SVC clot (Fig. 1). The CT scan was performed on a two-slice Siemens/Emotion Duo Isovue 300 scanner with standard protocol for PE with deep vein thrombosis. At our hospital, the patient’s CT scan was reviewed by experienced pediatric radiologists who concurred with the findings. He underwent a cardiac catheterization that revealed normal Fontan hemodynamics. The angiograms revealed a widely patent lateral tunnel and SVC communication to the pulmonary arteries, with no filling defects within the SVC, lateral tunnel, or branch pulmonary arteries (Fig. 2). The distal pulmonary arteries and pulmonary venous return appeared normal. The patient was discharged the next day in stable clinical condition with a diagnosis of noncardiac chest pain.

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