Azygos vein enlargement and cavo-suprahepatic regurgitation in massive pulmonary embolism

Excerpt

A 19-year-old woman presented with a 24-h history of dyspnea and syncope. Upon admission, she was in circulatory shock and acute respiratory failure. She was drowsy and exhibited jugular turgescence. The electrocardiogram showed sinus rhythm with a right bundle-branch block, while the chest-X ray was normal. Transthoracic echocardiography revealed acute cor pulmonale with an estimated systolic pulmonary arterial pressure of 50 mmHg. Contrast-enhanced chest computed tomography showed evidence of a massive “saddle” embolus straddling the bifurcation of the main pulmonary artery (Fig. 1) with almost total obliteration of both pulmonary arteries. Acute pulmonary hypertension led to the dilatation of the arch of the azygos vein (Fig. 2) and the inferior vena cava with a massive cavo-suprahepatic reflux (Fig. 3). The patient was successfully treated with intravenous tissue plasminogen activator associated with supportive care including oxygen and norepinephrine.

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